Provider Demographics
NPI:1508062662
Name:COOK, MARSHALL STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:STEVEN
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 1:4488 SUNNYSIDE BENCH RD
Mailing Address - Street 2:
Mailing Address - City:LENORE
Mailing Address - State:ID
Mailing Address - Zip Code:83541-9614
Mailing Address - Country:US
Mailing Address - Phone:208-476-5962
Mailing Address - Fax:
Practice Address - Street 1:4488 SUNNYSIDE BENCH RD
Practice Address - Street 2:
Practice Address - City:LENORE
Practice Address - State:ID
Practice Address - Zip Code:83541-9614
Practice Address - Country:US
Practice Address - Phone:208-476-5962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-6220207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine