Provider Demographics
NPI:1417928912
Name:COOK, JOHN CLYDE (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CLYDE
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 1:1005 E MATTHEWS
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401
Mailing Address - Country:US
Mailing Address - Phone:870-935-1242
Mailing Address - Fax:870-336-1355
Practice Address - Street 1:1005 E MATTHEWS
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401
Practice Address - Country:US
Practice Address - Phone:870-935-1242
Practice Address - Fax:870-336-1355
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5995208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
50291Medicare ID - Type Unspecified
D04332Medicare UPIN