Basic Information
| Provider Information | |||||||||
| NPI: | 1568455004 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COOK | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3513 US HWY 281 N | ||||||||
| Address2: | |||||||||
| City: | BLANCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182325784 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 W HIGHWAY 71 | ||||||||
| Address2: | |||||||||
| City: | MARBLE FALLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786548602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8302017100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2005 | ||||||||
| LastUpdateDate: | 03/11/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 24834 | OK | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | H8915 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 200083710A | 05 | OK | MEDICAID |