Provider Demographics
NPI:1457452427
Name:COOK, PATRICIA EVON (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:EVON
Last Name:COOK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7502 STATE RD
Mailing Address - Street 2:STE 3310
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-2596
Mailing Address - Country:US
Mailing Address - Phone:513-624-1240
Mailing Address - Fax:513-624-1290
Practice Address - Street 1:7502 STATE RD
Practice Address - Street 2:STE 3310
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-2596
Practice Address - Country:US
Practice Address - Phone:513-624-1240
Practice Address - Fax:513-624-1290
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043689207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0464466Medicaid
OHP00415966OtherMEDICARE RR
OH0476847Medicare PIN
OH0464466Medicaid