Individual
THOMAS RAY COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1444 PARKWAY DRIVE, BLACKFOOT, ID 83221
(208) 785-2600
Mailing address
669 S 700 E APT 18, ST GEORGE, UT 84770-2407
(801) 657-2232
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2180
ID
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
06/15/2020
Last updated
05/18/2022
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