Provider Demographics
NPI:1588222699
Name:COOK, MARC ALLAN (DO)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:ALLAN
Last Name:COOK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:390 NORTH LOOP RD
Mailing Address - Street 2:
Mailing Address - City:FORT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310
Mailing Address - Country:US
Mailing Address - Phone:760-383-5950
Mailing Address - Fax:844-818-9289
Practice Address - Street 1:390 NORTH LOOP RD
Practice Address - Street 2:
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310
Practice Address - Country:US
Practice Address - Phone:760-383-5950
Practice Address - Fax:844-818-9289
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102206617207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine