Provider Demographics
NPI:1609980903
Name:COOK, GEOFFREY H (MD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:H
Last Name:COOK
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 1:75 TORTILLA DR
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-3721
Mailing Address - Country:US
Mailing Address - Phone:928-282-1522
Mailing Address - Fax:928-282-7034
Practice Address - Street 1:75 TORTILLA DR
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-3721
Practice Address - Country:US
Practice Address - Phone:928-282-1522
Practice Address - Fax:928-282-7034
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ17774207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD86952Medicare UPIN
AZ860612109Medicare PIN
AZ0263570001Medicare NSC