Provider Demographics
NPI:1902825516
Name:COOK, JOHN R (CRNA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:COOK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1141
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-1141
Mailing Address - Country:US
Mailing Address - Phone:936-639-3036
Mailing Address - Fax:
Practice Address - Street 1:3810 HUGHES CT
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-6205
Practice Address - Country:US
Practice Address - Phone:936-639-3036
Practice Address - Fax:936-639-3064
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX045837367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82687UOtherBCBS
TX82687UOtherBCBS