Individual
EBEN G COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 531-5000
Mailing address
PO BOX 841656, DALLAS, TX 75284-1656
(903) 531-5000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
666435
TX
367500000X
Certified Registered Nurse Anesthetist
RN085133
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1127604
—
LA
05
—
308410501
—
TX
01
—
430074756
RAILROAD MEDICARE
—
01
—
750818167015
TRICARE
TX
01
—
8496UC
BCBS
TX
01
—
P01093186
RAIL ROAD
TX
Enumeration date
08/26/2005
Last updated
10/10/2014
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