Basic Information
| Provider Information | |||||||||
| NPI: | 1932512746 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COOK | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | LARRY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5342 DUDLEY BLVD | ||||||||
| Address2: | |||||||||
| City: | MCCLELLAN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956521012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074233000 | ||||||||
| FaxNumber: | 9165617566 | ||||||||
| Practice Location | |||||||||
| Address1: | 60 MDG/SGOP | ||||||||
| Address2: | 101 BODIN CIRCLE | ||||||||
| City: | TRAVIS AFB | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9165617793 | ||||||||
| FaxNumber: | 9165617566 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2014 | ||||||||
| LastUpdateDate: | 02/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 28929 | NE | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.