Provider Demographics
NPI:1538272133
Name:COOK, DAVID E (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:COOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2776 W 10755 S
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8645
Mailing Address - Country:US
Mailing Address - Phone:217-791-3670
Mailing Address - Fax:
Practice Address - Street 1:3800 W 3500 S
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-3306
Practice Address - Country:US
Practice Address - Phone:217-791-3670
Practice Address - Fax:801-572-1097
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10977432-1205208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01083153AOtherINDIANA STATE MEDICAL BOARD
UT10977432-1205OtherUTAH STATE MEDICAL BOARD