Provider Demographics
NPI:1063926343
Name:COOK, TREVOR (MD, AP)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:COOK
Suffix:
Gender:M
Credentials:MD, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HAMPTON VILLAGE PLZ STE 274
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2111
Mailing Address - Country:US
Mailing Address - Phone:314-312-3378
Mailing Address - Fax:
Practice Address - Street 1:16 HAMPTON VILLAGE PLZ STE 274
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2111
Practice Address - Country:US
Practice Address - Phone:314-312-3378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-26
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2017033635207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine