Individual
JAMES LEE COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1975 MARTHA AVE, STE A, IDAHO FALLS, ID 83404-7580
(208) 522-6930
(208) 523-5342
Mailing address
1975 MARTHA AVE, STE A, IDAHO FALLS, ID 83404-7580
(208) 522-6930
(208) 523-5342
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
PA460
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000060000
—
ID
01
—
10144509
BLUE SHIELD
ID
01
—
PAHR4
BLUE CROSS
ID
Enumeration date
10/23/2006
Last updated
03/10/2015
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