Provider Demographics
NPI:1588891071
Name:COOK, JEREMY L (DPM)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:L
Last Name:COOK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:550 PACIFIC COAST HIGHWAY
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740
Mailing Address - Country:US
Mailing Address - Phone:562-493-2451
Mailing Address - Fax:562-596-3157
Practice Address - Street 1:550 PACIFIC COAST HIGHWAY
Practice Address - Street 2:SUITE 209
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740
Practice Address - Country:US
Practice Address - Phone:562-493-2451
Practice Address - Fax:562-596-3157
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE4980213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery