Provider Demographics
NPI:1417946393
Name:COOK, REBECCA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ANN
Last Name:COOK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:COOK-JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:30633 N 46TH PL
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-5807
Mailing Address - Country:US
Mailing Address - Phone:623-518-0719
Mailing Address - Fax:480-427-4988
Practice Address - Street 1:30633 N 46TH PL
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-5807
Practice Address - Country:US
Practice Address - Phone:623-518-0719
Practice Address - Fax:480-427-4988
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23537207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ470253Medicaid
H01378Medicare UPIN
AZ470253Medicaid