Individual
MR. SHANE COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1445 E UTOPIA RD, PHOENIX, AZ 85024-3622
(602) 312-3505
Mailing address
1445 E UTOPIA RD, PHOENIX, AZ 85024-3622
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7407
AZ
Other
Enumeration date
04/08/2019
Last updated
04/08/2019
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