Basic Information
Provider Information
NPI: 1336572270
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COOK
FirstName: AARON
MiddleName: LAWSON
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3181 SW SAM JACKSON PARK RD
Address2: OHSU
City: PORTLAND
State: OR
PostalCode: 972393011
CountryCode: US
TelephoneNumber: 5034948220
FaxNumber:  
Practice Location
Address1: 3181 SW SAM JACKSON PARK RD
Address2: OHSU
City: PORTLAND
State: OR
PostalCode: 972393011
CountryCode: US
TelephoneNumber: 5034948220
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/14/2013
LastUpdateDate: 07/27/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/27/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207R00000XA159461CAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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