Provider Demographics
NPI:1174583561
Name:COOK, MARLON J (CRNA)
Entity type:Individual
Prefix:
First Name:MARLON
Middle Name:J
Last Name:COOK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79556-0506
Mailing Address - Country:US
Mailing Address - Phone:830-334-1485
Mailing Address - Fax:
Practice Address - Street 1:200 SOUTH IH 35
Practice Address - Street 2:
Practice Address - City:PEARSALL
Practice Address - State:TX
Practice Address - Zip Code:78061
Practice Address - Country:US
Practice Address - Phone:830-334-3617
Practice Address - Fax:830-334-9803
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX501684367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered