Provider Demographics
NPI:1508832171
Name:COOK, RANDY A (DO)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:A
Last Name:COOK
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2214 CANTERBURY DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2375
Mailing Address - Country:US
Mailing Address - Phone:785-623-2312
Mailing Address - Fax:785-623-2323
Practice Address - Street 1:2214 CANTERBURY DR
Practice Address - Street 2:SUITE 202
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2375
Practice Address - Country:US
Practice Address - Phone:785-623-2312
Practice Address - Fax:785-623-2323
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2009-12-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS05-19914207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100232820BMedicaid
KS100232820BMedicaid
KSB69108Medicare UPIN