Provider Demographics
NPI:1942281308
Name:COOK, THOMAS M (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:COOK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7980 N MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-2328
Mailing Address - Country:US
Mailing Address - Phone:937-280-4988
Mailing Address - Fax:937-280-4994
Practice Address - Street 1:7980 N MAIN ST.
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-2328
Practice Address - Country:US
Practice Address - Phone:937-280-4988
Practice Address - Fax:937-280-4994
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007054C207X00000X
OH34-00-7054C207X00000X
OH34-007054C207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00057974OtherMEDICARE RR
OH2223105Medicaid
OHP00057974OtherMEDICARE RR
OH2223105Medicaid
OH0874429Medicare PIN