Provider Demographics
NPI:1750369203
Name:COOK CHILDREN'S PHYSICIAN NETWORK
Entity type:Organization
Organization Name:COOK CHILDREN'S PHYSICIAN NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CCPN
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:V
Authorized Official - Last Name:DZURIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:682-885-1416
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1860
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-6800
Practice Address - Fax:682-885-6729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00N04AMedicare PIN
TX00N60XMedicare PIN
TX00U90BMedicare PIN
TX00L98BMedicare PIN
TX00L98SMedicare PIN
TX00487KMedicare PIN
TX00L46SMedicare PIN
TX00T26UMedicare PIN
TX00418KMedicare PIN
TX0097AXMedicare PIN
TX00L52VMedicare PIN
TX00T23UMedicare PIN
TX00257TMedicare PIN
TX00147TMedicare PIN
TX00568TMedicare PIN
TX00593NMedicare PIN
TX0069AXMedicare PIN
TX00K91VMedicare PIN
TX00R78HMedicare PIN
TX00U87ZMedicare PIN