Provider Demographics
NPI:1700942679
Name:COOK, PERRY F (MD)
Entity type:Individual
Prefix:
First Name:PERRY
Middle Name:F
Last Name:COOK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3121
Mailing Address - Country:US
Mailing Address - Phone:307-332-2357
Mailing Address - Fax:307-332-4276
Practice Address - Street 1:295 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3121
Practice Address - Country:US
Practice Address - Phone:307-335-6451
Practice Address - Fax:307-335-6467
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5166A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW306548Medicare PIN
F50095Medicare UPIN