Provider Demographics
NPI:1386603553
Name:COOK, JUDSON HOWARD (MD)
Entity type:Individual
Prefix:
First Name:JUDSON
Middle Name:HOWARD
Last Name:COOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 BLUEGRASS CIR
Mailing Address - Street 2:STE 170
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-7323
Mailing Address - Country:US
Mailing Address - Phone:307-778-2860
Mailing Address - Fax:307-778-2866
Practice Address - Street 1:1950 BLUEGRASS CIR
Practice Address - Street 2:STE 170
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-7323
Practice Address - Country:US
Practice Address - Phone:307-778-2860
Practice Address - Fax:307-778-2866
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6709A207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY119195100Medicaid
WY119195100Medicaid
WY10092Medicare ID - Type Unspecified