Provider Demographics
NPI:1740282425
Name:COOK, DAVID ALLEN (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLEN
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 1:130 LA CASA VIA
Mailing Address - Street 2:BLDG 2 STE 209
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3045
Mailing Address - Country:US
Mailing Address - Phone:925-935-6252
Mailing Address - Fax:925-930-0942
Practice Address - Street 1:130 LA CASA VIA
Practice Address - Street 2:BLDG 2 STE 209
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3045
Practice Address - Country:US
Practice Address - Phone:925-935-6252
Practice Address - Fax:925-930-0942
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33759207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G337590Medicare ID - Type Unspecified
CAA45670Medicare UPIN