Provider Demographics
NPI:1801893375
Name:COOK, LORAN TODD (MD)
Entity type:Individual
Prefix:DR
First Name:LORAN
Middle Name:TODD
Last Name:COOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:L.
Other - Middle Name:TODD
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1055 N 300 W
Mailing Address - Street 2:204
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3344
Mailing Address - Country:US
Mailing Address - Phone:801-357-7373
Mailing Address - Fax:
Practice Address - Street 1:1055 N 300 W
Practice Address - Street 2:STE 204
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
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT49624391205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD4391Medicaid
UT000060564Medicare PIN
UTD4391Medicaid