Provider Demographics
NPI:1548447824
Name:YURI E. COOK, M.D., PA
Entity type:Organization
Organization Name:YURI E. COOK, M.D., PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YURI
Authorized Official - Middle Name:E
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-644-0280
Mailing Address - Street 1:1111 RAINTREE CIR STE 240
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4902
Mailing Address - Country:US
Mailing Address - Phone:214-644-0280
Mailing Address - Fax:214-644-0294
Practice Address - Street 1:1111 RAINTREE CIR STE 240
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4902
Practice Address - Country:US
Practice Address - Phone:214-644-0280
Practice Address - Fax:214-644-0294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129982807Medicaid