Basic Information
| Provider Information | |||||||||
| NPI: | 1598984825 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOK | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | WAYNE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 UNIVERSITY BLVD | ||||||||
| Address2: | ROUTE # 0591 | ||||||||
| City: | GALVESTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775550591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4097721221 | ||||||||
| FaxNumber: | 4097721224 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 UNIVERSITY BLVD | ||||||||
| Address2: | ROUTE # 0591 | ||||||||
| City: | GALVESTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775550591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4097721221 | ||||||||
| FaxNumber: | 4097721224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2007 | ||||||||
| LastUpdateDate: | 11/18/2009 | ||||||||
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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 | 390200000X | AR | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207L00000X | N-3575 | TX | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | N-3575 | TX | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | E-5861 | AR | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 204377001 | 05 | TX | MEDICAID |