Provider Demographics
NPI:1699700930
Name:COOK, WILLIAM R (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:COOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 CARLTON ST
Mailing Address - Street 2:
Mailing Address - City:WAUCHULA
Mailing Address - State:FL
Mailing Address - Zip Code:33873-3400
Mailing Address - Country:US
Mailing Address - Phone:863-767-0522
Mailing Address - Fax:863-767-0572
Practice Address - Street 1:463 CARLTON ST
Practice Address - Street 2:
Practice Address - City:WAUCHULA
Practice Address - State:FL
Practice Address - Zip Code:33873-3400
Practice Address - Country:US
Practice Address - Phone:863-767-0522
Practice Address - Fax:863-767-0572
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01073621207RC0000X
FLME62166207RC0000X
PAMD028628E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009461800004Medicaid
IN187730023Medicare PIN
E71724Medicare UPIN