Provider Demographics
NPI:1528353877
Name:COOK, JIM MATTSON (DO)
Entity type:Individual
Prefix:DR
First Name:JIM
Middle Name:MATTSON
Last Name:COOK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3122 E MERIDIAN PARK LOOP
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654
Mailing Address - Country:US
Mailing Address - Phone:907-357-9590
Mailing Address - Fax:907-357-9593
Practice Address - Street 1:3122 E MERIDIAN PARK LOOP
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-357-9590
Practice Address - Fax:907-357-9593
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2015-07-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AK8233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine