Provider Demographics
NPI:1689806523
Name:CANADIAN FAMILY PHYSICIANS, PLLC
Entity Type:Organization
Organization Name:CANADIAN FAMILY PHYSICIANS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:COOKL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-323-8882
Mailing Address - Street 1:1025 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CANADIAN
Mailing Address - State:TX
Mailing Address - Zip Code:79014-3047
Mailing Address - Country:US
Mailing Address - Phone:806-323-8882
Mailing Address - Fax:806-323-6108
Practice Address - Street 1:1025 S 3RD ST
Practice Address - Street 2:
Practice Address - City:CANADIAN
Practice Address - State:TX
Practice Address - Zip Code:79014-3047
Practice Address - Country:US
Practice Address - Phone:806-323-8882
Practice Address - Fax:806-323-6108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7695171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherFIRSTCARE