Organization Name: | W BRYCE COOK |
NPI Number: | 1093948010 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | W BRYCE COOK (OWNER) |
Mailing Address: | 990 Medical Dr #u3 Brigham City |
State: | UT US |
Postal Code: | 843024713 |
Phone Number: | 4357349623 |
Fax Number: | 4357527159 |
NPI Enumeration Date: | 08/25/2009 |
NPI Last Update Date: | 03/05/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | 1032580501 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |