Provider Demographics
NPI:1275508574
Name:COOK, CHARLES MILTON (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MILTON
Last Name:COOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7247
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97475-0011
Mailing Address - Country:US
Mailing Address - Phone:541-686-9551
Mailing Address - Fax:541-687-6716
Practice Address - Street 1:3333 RIVERBEND DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-8800
Practice Address - Country:US
Practice Address - Phone:541-222-3154
Practice Address - Fax:541-222-3359
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14613207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR050005893OtherRR MEDICARE
WA1020130Medicaid
OR178970Medicaid
CAXPY194083Medicaid
OR050005893OtherRR MEDICARE
CAXPY194083Medicaid