Basic Information
| Provider Information | |||||||||
| NPI: | 1982602124 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOK | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | ALBERT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1210 GEMINI PLACE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432406110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142624263 | ||||||||
| FaxNumber: | 6142620822 | ||||||||
| Practice Location | |||||||||
| Address1: | 1210 GEMINI PLACE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432406110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142624263 | ||||||||
| FaxNumber: | 6142620822 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2005 | ||||||||
| LastUpdateDate: | 07/18/2019 | ||||||||
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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 | 207XS0106X | 35-06-5956-C | OH | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0246380 | 05 | OH | MEDICAID |