Provider Demographics
NPI:1861595449
Name:COOK, LUCIUS PINCKNEY III (MD)
Entity type:Individual
Prefix:DR
First Name:LUCIUS
Middle Name:PINCKNEY
Last Name:COOK
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7777 FOREST LN
Mailing Address - Street 2:#B-218
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6811
Mailing Address - Country:US
Mailing Address - Phone:972-566-7655
Mailing Address - Fax:972-566-3853
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:#B-218
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6811
Practice Address - Country:US
Practice Address - Phone:972-566-7655
Practice Address - Fax:972-566-3853
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE3168207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C14720Medicare UPIN
00R547Medicare ID - Type Unspecified