Provider Demographics
NPI:1558437681
Name:COOKE, W DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:W DONALD
Middle Name:
Last Name:COOKE
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 1:1800 EAST 3RD AVE #104
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5046
Mailing Address - Country:US
Mailing Address - Phone:970-259-0780
Mailing Address - Fax:970-382-2620
Practice Address - Street 1:1800 EAST 3RD AVE #104
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5046
Practice Address - Country:US
Practice Address - Phone:970-259-0780
Practice Address - Fax:970-382-2620
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34262207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01342625Medicaid
COC20311Medicare ID - Type Unspecified
CO01342625Medicaid