Provider Demographics
NPI:1891795217
Name:COOK, JOHN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
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 1:7959 BROADWAY ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2667
Mailing Address - Country:US
Mailing Address - Phone:210-826-0311
Mailing Address - Fax:210-805-9523
Practice Address - Street 1:7959 BROADWAY ST
Practice Address - Street 2:SUITE 600
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2667
Practice Address - Country:US
Practice Address - Phone:210-826-0311
Practice Address - Fax:210-805-9523
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1945208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4552709OtherAETNA
TX89W831OtherBLUE CROSS BLUE SHIELD
TX89W831OtherBLUE CROSS BLUE SHIELD