Provider Demographics
NPI:1003247230
Name:COOK, BENJAMIN JOSEPH (PA-S)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:JOSEPH
Last Name:COOK
Suffix:
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5241 SPARKS RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27020-8348
Mailing Address - Country:US
Mailing Address - Phone:336-244-6640
Mailing Address - Fax:
Practice Address - Street 1:5241 SPARKS RD
Practice Address - Street 2:
Practice Address - City:HAMPTONVILLE
Practice Address - State:NC
Practice Address - Zip Code:27020-8348
Practice Address - Country:US
Practice Address - Phone:336-244-6640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant