Provider Demographics
NPI:1053318980
Name:COOK, KATHERINE SUE (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:SUE
Last Name:COOK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-2102
Mailing Address - Country:US
Mailing Address - Phone:573-364-1900
Mailing Address - Fax:573-364-7365
Practice Address - Street 1:700 W 11TH ST
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2102
Practice Address - Country:US
Practice Address - Phone:573-364-1900
Practice Address - Fax:573-364-7365
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4F55208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
A13117Medicare UPIN