Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | AZ19360 | AZ |
NPI | 1205813318 |
---|---|
Provider Name | Marshall Lewis Cook |
First Address | Scottsdale, AZ 85258-5557 |
Second Address | Scottsdale, AZ 85258-5557 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 07/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E78341 | (02) | AZ |