Provider Demographics
NPI:1174509590
Name:COOK, LANE MARSHALL (MD)
Entity Type:Individual
Prefix:DR
First Name:LANE
Middle Name:MARSHALL
Last Name:COOK
Suffix:
Gender:M
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:PO BOX 10187
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37939-0187
Mailing Address - Country:US
Mailing Address - Phone:865-588-6425
Mailing Address - Fax:865-584-8066
Practice Address - Street 1:4428 SUTHERLAND AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5008
Practice Address - Country:US
Practice Address - Phone:865-588-6425
Practice Address - Fax:865-584-8066
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-17
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0147482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3713251OtherMEDICARE INDIVIDUAL PTAN
TN25080OtherBLUE CROSS IDENTIFIER
TN3713251Medicaid
TNA96767Medicare UPIN