Provider Demographics
NPI:1750487609
Name:LORAN D COOK MD PC
Entity type:Organization
Organization Name:LORAN D COOK MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LORAN
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-357-7373
Mailing Address - Street 1:1055 N 300 W STE 204
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3374
Mailing Address - Country:US
Mailing Address - Phone:801-357-7373
Mailing Address - Fax:801-357-7217
Practice Address - Street 1:1055 N 300 W STE 204
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3374
Practice Address - Country:US
Practice Address - Phone:801-357-7373
Practice Address - Fax:801-357-7217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT921109409934152W00000X
UT465810019174400000X
UT49624391205174400000X
UT0767410010174400000X
UT9018279011205174400000X
UT931131489934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTA88149Medicare UPIN
UTT78116Medicare UPIN
UTG86346Medicare UPIN
UTU53033Medicare UPIN
UTD07776Medicare UPIN
UTH42850Medicare UPIN