Provider Demographics
NPI:1437225786
Name:COOK, KEITH GEORGE (M D)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:GEORGE
Last Name:COOK
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3959 E 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-1657
Mailing Address - Country:US
Mailing Address - Phone:303-452-4343
Mailing Address - Fax:
Practice Address - Street 1:3959 E 120TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-1657
Practice Address - Country:US
Practice Address - Phone:303-452-4343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29364207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01293646Medicaid
20131Medicare ID - Type Unspecified
COC14735Medicare UPIN