Provider Demographics
NPI:1487636940
Name:FREISLEBEN-COOK, LOIS ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:LOIS
Middle Name:ANNE
Last Name:FREISLEBEN-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 1:6155 MARGE CT
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-6696
Mailing Address - Country:US
Mailing Address - Phone:707-397-0431
Mailing Address - Fax:707-497-6678
Practice Address - Street 1:6155 MARGE CT
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-6696
Practice Address - Country:US
Practice Address - Phone:707-397-0431
Practice Address - Fax:707-497-6678
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2015-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT102332080P0006X, 208000000X
ND8215208000000X, 2080P0006X
CAG45968208000000X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics