Provider Demographics
NPI:1083743322
Name:COOKE, BERNARD MARION JR (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:MARION
Last Name:COOKE
Suffix:JR
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:12626 RIVERSIDE DR
Mailing Address - Street 2:SUITE 503
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3420
Mailing Address - Country:US
Mailing Address - Phone:818-980-1088
Mailing Address - Fax:818-980-1752
Practice Address - Street 1:12626 RIVERSIDE DR
Practice Address - Street 2:SUITE 503
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91607-3420
Practice Address - Country:US
Practice Address - Phone:818-980-1088
Practice Address - Fax:818-980-1752
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG28473207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G284730Medicaid
CA00G284730Medicaid