Provider Demographics
NPI:1932381696
Name:COOK, BRIAN E (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:E
Last Name:COOK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 E PROSPER TRL
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-9147
Mailing Address - Country:US
Mailing Address - Phone:469-481-3001
Mailing Address - Fax:972-347-1394
Practice Address - Street 1:2440 E PROSPER TRL
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-9147
Practice Address - Country:US
Practice Address - Phone:469-481-3001
Practice Address - Fax:972-347-1394
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-003153363A00000X
TXPA06264363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ71190Medicare PIN