Individual
MATTHEW S COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2042 NE WILLIAMSON CT, BEND, OR 97701-3760
(541) 706-6905
(541) 706-6906
Mailing address
PO BOX 5579, BEND, OR 97708-5579
(541) 706-5811
(541) 706-5867
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA150453
OR
363AM0700X
Medical Physician Assistant
002061
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00887737
MEDICARE RAILROAD
OR
05
—
500614079
—
OR
Enumeration date
02/15/2008
Last updated
05/29/2020
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