Provider Demographics
NPI:1427054477
Name:COOK, THOMAS (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
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:PO BOX 7420
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93290-7420
Mailing Address - Country:US
Mailing Address - Phone:559-713-0117
Mailing Address - Fax:559-713-1996
Practice Address - Street 1:805 W ACEQUIA AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6162
Practice Address - Country:US
Practice Address - Phone:559-713-0117
Practice Address - Fax:559-713-1996
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2014-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68280207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A46143Medicare UPIN
00A68280Medicare ID - Type Unspecified