Provider Demographics
NPI:1932206976
Name:COOK, JANE CATHERINE (DO)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:CATHERINE
Last Name:COOK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 6TH ST S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4630
Mailing Address - Country:US
Mailing Address - Phone:727-767-3318
Mailing Address - Fax:727-767-8002
Practice Address - Street 1:501 6TH ST S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4630
Practice Address - Country:US
Practice Address - Phone:727-767-3318
Practice Address - Fax:727-767-8002
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-57772085R0202X, 2085P0229X
FLOS104492085P0229X
MI51010145792085P0229X
OH34.0086832085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
43545600OtherEDS
700C610000OtherBCBS
MI1932206976Medicaid
FL000925800Medicaid
700C610000OtherBCBS