Provider Demographics
NPI:1073500823
Name:COOK, LAUREL B I (DPM)
Entity type:Individual
Prefix:DR
First Name:LAUREL
Middle Name:B
Last Name:COOK
Suffix:I
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:LAUREL
Other - Middle Name:B
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:709 E MEADECREST DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-2441
Mailing Address - Country:US
Mailing Address - Phone:865-981-4595
Mailing Address - Fax:865-981-4544
Practice Address - Street 1:603 SMITHVIEW DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37803-6100
Practice Address - Country:US
Practice Address - Phone:865-981-4595
Practice Address - Fax:865-981-4544
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN641213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4127412Medicaid
TN3328913Medicare PIN
TN4127412Medicaid
TN3328913Medicare ID - Type UnspecifiedINDIVIDUAL
TNU71317Medicare UPIN