Provider Demographics
NPI:1558619338
Name:COOK, JERED M (MD)
Entity Type:Individual
Prefix:DR
First Name:JERED
Middle Name:M
Last Name:COOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3433 NW 56TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4430
Mailing Address - Country:US
Mailing Address - Phone:405-947-3341
Mailing Address - Fax:405-917-3590
Practice Address - Street 1:3433 NW 56TH ST STE 660
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4449
Practice Address - Country:US
Practice Address - Phone:405-947-3341
Practice Address - Fax:405-917-3590
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK34453207RC0000X
OH35132183208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0304338Medicaid
OK200849050AMedicaid