Provider Demographics
NPI:1215016399
Name:ROBERT D COOK MD PC
Entity Type:Organization
Organization Name:ROBERT D COOK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-692-3250
Mailing Address - Street 1:19875 SW 65TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8353
Mailing Address - Country:US
Mailing Address - Phone:503-692-3250
Mailing Address - Fax:503-691-2212
Practice Address - Street 1:19875 SW 65TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8353
Practice Address - Country:US
Practice Address - Phone:503-692-3250
Practice Address - Fax:503-691-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD07347174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR232652Medicaid
OR135481Medicare PIN
ORC92431Medicare UPIN