Provider Demographics
NPI:1174711204
Name:COOK, GREGORY GERARD (DPM)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:GERARD
Last Name:COOK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 UPPER CREEK DR STE 106
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6844
Mailing Address - Country:US
Mailing Address - Phone:727-824-5100
Mailing Address - Fax:727-824-5132
Practice Address - Street 1:4040 UPPER CREEK DR STE 106
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-6844
Practice Address - Country:US
Practice Address - Phone:813-645-1993
Practice Address - Fax:727-824-5132
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0002468213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65402YMedicare PIN