Provider Demographics
NPI:1205843034
Name:COOK, JEANNE WYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:WYNN
Last Name:COOK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1815 ALTA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-3152
Mailing Address - Country:US
Mailing Address - Phone:512-387-5813
Mailing Address - Fax:512-277-6016
Practice Address - Street 1:2324 E CESAR CHAVEZ ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-4604
Practice Address - Country:US
Practice Address - Phone:512-387-5813
Practice Address - Fax:512-277-6016
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2015-06-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXH2315207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC14721Medicare UPIN