Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 3406870501 | UT |
N | 222Z00000X | Podiatrist | 3406870501 | UT |
N | 213E00000X | Podiatrist | 540 | CO |
N | 222Z00000X | Podiatrist | 540 | CO |
Y | 213ES0131X | Foot Surgery | 540 | CO |
NPI | 1285636449 |
---|---|
Provider Name | Terry R Cook |
First Address | Cortez, CO 81321-8404 |
Second Address | Montezuma Creek, UT 84534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 19/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04023719 | (05) | CO |
50763 | BCBS OF CO (01) | CO |
609395 | HMO BCBS CO (01) | CO |
870579394001 | ROCKY MOUNTAIN HMO (01) | CO |