Individual
DARRYL BRUCE COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1151 HOSPITAL WAY BLDG A, POCATELLO, ID 83201-2763
(208) 232-6616
(208) 232-6618
Mailing address
PO BOX 4788, POCATELLO, ID 83205-4788
(208) 232-6616
(208) 232-6618
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
M4758
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002802900
—
ID
Enumeration date
07/24/2006
Last updated
07/09/2007
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