Provider Demographics
NPI:1417006560
Name:COOK, DOUGLAS WESLEY (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:WESLEY
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 1:470 GREENFIELD AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-3589
Mailing Address - Country:US
Mailing Address - Phone:559-584-2759
Mailing Address - Fax:559-584-2811
Practice Address - Street 1:470 GREENFIELD AVE STE 202
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3589
Practice Address - Country:US
Practice Address - Phone:559-584-2759
Practice Address - Fax:559-584-2811
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98414208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAP816ZMedicare PIN