Provider Demographics
NPI:1174678932
Name:COOK, JASON ANDREW HOOVER (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ANDREW HOOVER
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 1:3555 WILLOW LAKE BLVD.
Mailing Address - Street 2:SUITE 140
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55110-4462
Mailing Address - Country:US
Mailing Address - Phone:651-770-2124
Mailing Address - Fax:651-251-5282
Practice Address - Street 1:14712 VICTOR HUGO BLVD.
Practice Address - Street 2:SUITE 4
Practice Address - City:HUGO
Practice Address - State:MN
Practice Address - Zip Code:55038-9458
Practice Address - Country:US
Practice Address - Phone:651-777-2362
Practice Address - Fax:651-332-8554
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036119192208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2429394Medicaid