Provider Demographics
NPI:1043218340
Name:COOK, ROGER HARVEY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:HARVEY
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 1:1111 MEDICAL CTR. BLVD.
Mailing Address - Street 2:STE. S-850
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072
Mailing Address - Country:US
Mailing Address - Phone:504-349-6450
Mailing Address - Fax:504-349-6454
Practice Address - Street 1:1111 MEDICAL CTR. BLVD.
Practice Address - Street 2:STE. S-850
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072
Practice Address - Country:US
Practice Address - Phone:504-349-6450
Practice Address - Fax:504-349-6454
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0071012207Q00000X
LA206252207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM12677523Medicaid
NM12677523Medicaid
F85111Medicare UPIN