Provider Demographics
NPI:1194720052
Name:COOK, JACK T (PA-C)
Entity type:Individual
Prefix:MR
First Name:JACK
Middle Name:T
Last Name:COOK
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:250 PLEASANT STREET
Mailing Address - Street 2:YEAPLE BUILDING
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-7539
Mailing Address - Country:US
Mailing Address - Phone:603-228-7200
Mailing Address - Fax:603-228-7307
Practice Address - Street 1:250 PLEASANT STREET
Practice Address - Street 2:YEAPLE BUILDING
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7539
Practice Address - Country:US
Practice Address - Phone:603-228-7200
Practice Address - Fax:603-228-7307
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2013-06-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH432363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH222594672OtherGREATWEST HEALTHCARE
NH222594672OtherTRICARE
NH30334856Medicaid
NH378781OtherMVP HEALTHCARE
NH378781OtherMVP HEALTHCARE
NHP56775Medicare UPIN