Provider Demographics
NPI:1225033590
Name:COOK, JEFFREY NELSON (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:NELSON
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 1:2024 15TH ST
Mailing Address - Street 2:STE 5D
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4130
Mailing Address - Country:US
Mailing Address - Phone:601-553-2100
Mailing Address - Fax:601-553-2104
Practice Address - Street 1:2024 15TH ST
Practice Address - Street 2:STE 5D
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4130
Practice Address - Country:US
Practice Address - Phone:601-553-2100
Practice Address - Fax:601-553-2104
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS09097207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00116548Medicaid
MS180024836OtherRAILROAD MEDICARE
MS180000048Medicare PIN