Provider Demographics
NPI:1205196706
Name:COOK, ROBERT DAN SR
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DAN
Last Name:COOK
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 E EASTLAND ST
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-2809
Mailing Address - Country:US
Mailing Address - Phone:615-332-4303
Mailing Address - Fax:
Practice Address - Street 1:355 E EASTLAND ST
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-2809
Practice Address - Country:US
Practice Address - Phone:615-332-4303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor