Provider Demographics
NPI:1386866051
Name:COOK, DWAYNE ROBERT I (RT)
Entity Type:Individual
Prefix:MR
First Name:DWAYNE
Middle Name:ROBERT
Last Name:COOK
Suffix:I
Gender:M
Credentials:RT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2145
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23327-2145
Mailing Address - Country:US
Mailing Address - Phone:757-466-1163
Mailing Address - Fax:757-466-1178
Practice Address - Street 1:420 N CENTER DR
Practice Address - Street 2:SUITE 230
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4007
Practice Address - Country:US
Practice Address - Phone:757-466-1163
Practice Address - Fax:757-466-1178
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01200023672471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography