Individual
GLENN COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
G63727
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G637271
—
CA
01
—
0802380001
NORIDIAN PROVIDER NUMBER
CA
01
—
0802380003
CORONADO OFFICE NORIDIAN
CA
Enumeration date
12/12/2006
Last updated
01/19/2011
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