Provider Demographics
NPI:1417967928
Name:COOK, CHARLES EVERETT (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EVERETT
Last Name:COOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8440 WALNUT HILL LN
Mailing Address - Street 2:#110
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3833
Mailing Address - Country:US
Mailing Address - Phone:214-265-7175
Mailing Address - Fax:214-691-5940
Practice Address - Street 1:8440 WALNUT HILL LN
Practice Address - Street 2:#110
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3833
Practice Address - Country:US
Practice Address - Phone:214-265-7175
Practice Address - Fax:214-691-5940
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2013-12-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXG9724207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122178002Medicaid
TX122178002Medicaid
TXB62942Medicare UPIN