Provider Demographics
NPI:1396867156
Name:COOK, MARK R (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:COOK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1914 LELARAY ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-2800
Mailing Address - Country:US
Mailing Address - Phone:719-632-7641
Mailing Address - Fax:719-632-2925
Practice Address - Street 1:1914 LELARAY ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2800
Practice Address - Country:US
Practice Address - Phone:719-632-7641
Practice Address - Fax:719-632-7641
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47859207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000149831Medicaid