Provider Demographics
NPI:1215590393
Name:COOK, GRADY III (DO)
Entity Type:Individual
Prefix:
First Name:GRADY
Middle Name:
Last Name:COOK
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4431 E HIGHWAY 287 STE 100
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-4110
Mailing Address - Country:US
Mailing Address - Phone:972-817-7500
Mailing Address - Fax:972-817-7510
Practice Address - Street 1:4431 E HIGHWAY 287
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-4109
Practice Address - Country:US
Practice Address - Phone:972-817-7500
Practice Address - Fax:972-817-7510
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS9481207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine