Individual
RICHARD EDWARD COOKSLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
115 S PINE ST, CANYONVILLE, OR 97417-9648
(541) 839-4211
(541) 839-4983
Mailing address
PO BOX 888, CANYONVILLE, OR 97417-0888
(541) 839-4211
(541) 839-4983
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA00272
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
165878
—
OR
01
—
930087876
RAILROAD MEDICARE
OR
01
—
PA00272
STATE LICENSE
OR
Enumeration date
01/27/2006
Last updated
10/18/2018
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