Provider Demographics
NPI:1053388975
Name:COOK, EDWIN N (DO)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:N
Last Name:COOK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SIOUX VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:IA
Mailing Address - Zip Code:51012-1205
Mailing Address - Country:US
Mailing Address - Phone:712-225-5101
Mailing Address - Fax:712-225-6880
Practice Address - Street 1:300 SIOUX VALLEY DR
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:IA
Practice Address - Zip Code:51012-1205
Practice Address - Country:US
Practice Address - Phone:712-225-5101
Practice Address - Fax:712-225-6880
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA30278OtherBLUE CROSS # CHEROKEE SIT
IA300135030OtherRAILROAD MEDICARE #
IA3518563Medicaid
IA4518563Medicaid
IA30285OtherBLUE CROSS # IDA GROVE SI
IA3518563Medicaid
IA300135030OtherRAILROAD MEDICARE #