Provider Demographics
NPI:1467443580
Name:COOK, JOHN C (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:COOK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 5TH STREET SE
Mailing Address - Street 2:SUITE G
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-4225
Mailing Address - Country:US
Mailing Address - Phone:330-745-3151
Mailing Address - Fax:330-745-9984
Practice Address - Street 1:101 5TH STREET SE
Practice Address - Street 2:SUITE G
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-4225
Practice Address - Country:US
Practice Address - Phone:330-745-3151
Practice Address - Fax:330-745-9984
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005018C207Q00000X
OH34-005018207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHQ018628AOtherHOMETOWN
OH0857694Medicaid
4230305OtherAETNA
OH198OtherSUMMACARE
OH0716056Medicare PIN
OHCO0716056Medicare PIN
4230305OtherAETNA
OHQ018628AOtherHOMETOWN
OH0857694Medicaid