Provider Demographics
NPI:1356461651
Name:JONATHAN F COOK, MD INC
Entity Type:Organization
Organization Name:JONATHAN F COOK, MD INC
Other - Org Name:BRENT W MILLER MD, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:TENNYSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-599-1400
Mailing Address - Street 1:1334 W. COVINA BL.
Mailing Address - Street 2:# 204
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773
Mailing Address - Country:US
Mailing Address - Phone:909-599-1400
Mailing Address - Fax:909-599-2044
Practice Address - Street 1:1334 W. COVINA BL.
Practice Address - Street 2:# 204
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773
Practice Address - Country:US
Practice Address - Phone:909-599-1400
Practice Address - Fax:909-599-2044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2009-07-24
Deactivation Date:2008-12-02
Deactivation Code:
Reactivation Date:2009-07-22
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14228Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER