Provider Demographics
NPI:1003815325
Name:COOK, STANLEY D (MD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:D
Last Name:COOK
Suffix:
Gender:M
Credentials:MD
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 3780
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79116-3780
Mailing Address - Country:US
Mailing Address - Phone:806-355-3352
Mailing Address - Fax:806-355-5367
Practice Address - Street 1:1901 MEDI PARK DR
Practice Address - Street 2:SUITE 2050
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2110
Practice Address - Country:US
Practice Address - Phone:806-355-3352
Practice Address - Fax:806-355-5367
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG75032085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129122103Medicaid
TX8F7707OtherBLUE CROSS OF TEXAS
TXMDG7503OtherTEXAS WORKERS COMPENSATIO
OK100130410AMedicaid
TX129122106Medicaid
751375446OtherTAX ID
P00338146OtherRAILROAD MEDICARE
NM16533038Medicaid
137298101OtherFIRSTCARE
751375446OtherTAX ID
TX129122106Medicaid
TX129122103Medicaid
TX8F7901Medicare PIN