Provider Demographics
NPI:1245396191
Name:COOK, ALBERT PAUL (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:PAUL
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 1408
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92546-1408
Mailing Address - Country:US
Mailing Address - Phone:951-652-8840
Mailing Address - Fax:951-652-8847
Practice Address - Street 1:301 N SAN JACINTO STREET
Practice Address - Street 2:STE 101
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543
Practice Address - Country:US
Practice Address - Phone:951-765-1712
Practice Address - Fax:951-765-1716
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22030174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A220302Medicare PIN
A220302Medicare UPIN