Provider Demographics
NPI:1295836245
Name:COOK, IAN KEITH (DPM)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:KEITH
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 1:4100 SION FARM COMMERCIAL CENTER
Mailing Address - Street 2:
Mailing Address - City:C'STED ST CROIX
Mailing Address - State:VI
Mailing Address - Zip Code:00820
Mailing Address - Country:US
Mailing Address - Phone:340-713-8397
Mailing Address - Fax:340-719-5103
Practice Address - Street 1:4100 SION FARM COMMERCIAL CENTER
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED ST CROIX
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-713-8397
Practice Address - Fax:340-719-5103
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005172213E00000X
VI1058213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VIBY120BMedicare PIN
VI1142970002Medicare NSC
VIBY120AMedicare PIN
NYU51504Medicare UPIN