Provider Demographics
NPI:1316989569
Name:COOK, W BRYCE (DPM)
Entity type:Individual
Prefix:
First Name:W
Middle Name:BRYCE
Last Name:COOK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 E 1400 N
Mailing Address - Street 2:STE B
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2406
Mailing Address - Country:US
Mailing Address - Phone:435-752-9011
Mailing Address - Fax:435-752-7159
Practice Address - Street 1:550 E 1400 N
Practice Address - Street 2:STE B
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2450
Practice Address - Country:US
Practice Address - Phone:435-752-9011
Practice Address - Fax:435-752-7159
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1032580501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1032580501OtherSTATE LIC #
UT1032580501OtherSTATE LIC #
UTAC8838104OtherDEA