Provider Demographics
NPI:1699749770
Name:COOKE, WILLIAM E JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:E
Last Name:COOKE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:203 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-4208
Mailing Address - Country:US
Mailing Address - Phone:765-973-9294
Mailing Address - Fax:765-973-9233
Practice Address - Street 1:25 W MAIN ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:IN
Practice Address - Zip Code:47102
Practice Address - Country:US
Practice Address - Phone:812-794-8100
Practice Address - Fax:812-794-8200
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056407A207QA0401X, 207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200392200Medicaid
IN200490500AMedicaid
IN200490500AMedicaid
IN218850AMedicare PIN
IN153883Medicare Oscar/Certification