Provider Demographics
NPI:1093738726
Name:COOK, LOREN NICHOLS (MD)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:NICHOLS
Last Name:COOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4528 CHAPMAN HWY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-4359
Mailing Address - Country:US
Mailing Address - Phone:865-579-3920
Mailing Address - Fax:865-579-3963
Practice Address - Street 1:4528 CHAPMAN HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-4359
Practice Address - Country:US
Practice Address - Phone:865-579-3920
Practice Address - Fax:865-579-3963
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD24518207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3076408Medicaid
TN3076408Medicaid
TN3076409Medicare Oscar/Certification
TND90096Medicare UPIN