Provider Demographics
NPI:1558504548
Name:COOK, GREGORY BRYCE (DPM)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:BRYCE
Last Name:COOK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 E 1400 N STE B
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2450
Mailing Address - Country:US
Mailing Address - Phone:435-752-9011
Mailing Address - Fax:435-752-7159
Practice Address - Street 1:550 E 1400 N STE B
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2450
Practice Address - Country:US
Practice Address - Phone:435-752-9011
Practice Address - Fax:435-752-7159
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT72759630501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery