Provider Demographics
NPI:1083701890
Name:COOK, DONALD GLENN (AUD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:GLENN
Last Name:COOK
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-6884
Mailing Address - Country:US
Mailing Address - Phone:325-949-9555
Mailing Address - Fax:512-260-2668
Practice Address - Street 1:3605 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-6884
Practice Address - Country:US
Practice Address - Phone:325-949-9555
Practice Address - Fax:512-260-2668
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50961237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F5010Medicare PIN