Provider Demographics
NPI:1285636449
Name:COOK, TERRY R (DPM)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:R
Last Name:COOK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25543 ROAD N.6 LOOP
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-8404
Mailing Address - Country:US
Mailing Address - Phone:970-565-8660
Mailing Address - Fax:
Practice Address - Street 1:1478 EAST HWY 162
Practice Address - Street 2:
Practice Address - City:MONTEZUMA CREEK
Practice Address - State:UT
Practice Address - Zip Code:84534
Practice Address - Country:US
Practice Address - Phone:435-651-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO540213E00000X, 213ES0131X
UT3406870501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO609395OtherHMO BCBS CO
CO04023719Medicaid
CO870579394001OtherROCKY MOUNTAIN HMO
CO50763OtherBCBS OF CO
CO50763OtherBCBS OF CO
CO480030679Medicare ID - Type UnspecifiedUHC RAILROAD MEDICARE
CO870579394001OtherROCKY MOUNTAIN HMO
UT000011913Medicare ID - Type UnspecifiedUT MEDICARE