Individual
MR. GARY S COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
1207 N VIRGINIA ST, PORT LAVACA, TX 77979-2506
(361) 746-1588
(361) 400-1588
Mailing address
1207 N VIRGINIA ST, PORT LAVACA, TX 77979-2506
(361) 746-1588
(361) 400-1588
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA0086
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
453897
—
TX
Enumeration date
06/11/2005
Last updated
05/01/2014
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