Individual
TIMOTHY COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
122 WYOMING ST, DAYTON, OH 45409-2731
(937) 438-8640
Mailing address
642 RESIDENZ PKWY APT A, KETTERING, OH 45429-6291
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.007996
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50.007996RX
OHIO STATE MEDICAL BOARD
OH
Enumeration date
01/25/2023
Last updated
03/02/2023
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