Individual
MR. JACK T. COOK
Active
Individual
MR. JACK T. COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
432
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
222594672
GREATWEST HEALTHCARE
NH
05
—
30334856
—
NH
01
—
378781
MVP HEALTHCARE
NH
Enumeration date
06/16/2005
Last updated
06/24/2013
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