Provider Demographics
NPI:1497070486
Name:COOK, MACKENZIE RAINIER (MD)
Entity Type:Individual
Prefix:DR
First Name:MACKENZIE
Middle Name:RAINIER
Last Name:COOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:MAIL CODE: L223
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239
Mailing Address - Country:US
Mailing Address - Phone:860-463-5727
Mailing Address - Fax:
Practice Address - Street 1:3181 SW SAM JACKSON PARK ROAD
Practice Address - Street 2:OHSU
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-2393
Practice Address - Country:US
Practice Address - Phone:503-494-5300
Practice Address - Fax:503-494-6519
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD184572208600000X, 2086S0102X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care