Provider Demographics
NPI:1710769377
Name:COOK, TARA (RVT, RDMS)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:RVT, RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21055 PICKENS RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:77880-5315
Mailing Address - Country:US
Mailing Address - Phone:281-883-4825
Mailing Address - Fax:
Practice Address - Street 1:112 FARQUHAR ST
Practice Address - Street 2:
Practice Address - City:NAVASOTA
Practice Address - State:TX
Practice Address - Zip Code:77868-3616
Practice Address - Country:US
Practice Address - Phone:281-883-4825
Practice Address - Fax:832-995-0176
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX730592085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound