Basic Information
Provider Information
NPI: 1447478292
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COOK
FirstName: ALAN
MiddleName: D
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3030 N CENTRAL AVE STE 1001
Address2:  
City: PHOENIX
State: AZ
PostalCode: 850122716
CountryCode: US
TelephoneNumber: 6024064786
FaxNumber: 9166364358
Practice Location
Address1: 485 S DOBSON RD
Address2: SUITE 201
City: CHANDLER
State: AZ
PostalCode: 852245602
CountryCode: US
TelephoneNumber: 4807284700
FaxNumber: 4807284747
Other Information
ProviderEnumerationDate: 04/24/2007
LastUpdateDate: 07/15/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000X48680AZN Allopathic & Osteopathic PhysiciansSurgery 
2086S0127XM6577TXN Allopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
2086S0127X48680AZY Allopathic & Osteopathic PhysiciansSurgeryTrauma Surgery

No ID Information.


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