Provider Demographics
NPI:1518959147
Name:COOK, GEORGE A (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:A
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 1:1010 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CANADIAN
Mailing Address - State:TX
Mailing Address - Zip Code:79014-3315
Mailing Address - Country:US
Mailing Address - Phone:806-323-8882
Mailing Address - Fax:806-323-6108
Practice Address - Street 1:1010 S 4TH ST
Practice Address - Street 2:
Practice Address - City:CANADIAN
Practice Address - State:TX
Practice Address - Zip Code:79014-3315
Practice Address - Country:US
Practice Address - Phone:806-323-8882
Practice Address - Fax:806-323-6108
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7695207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178531301Medicaid
TX0098MQOtherBCBS OF TX
TX145528100OtherFIRSTCARE
TX178529701OtherTX HEALTHSTEPS