Provider Demographics
NPI:1477532356
Name:COOK, DAVID M (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:COOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-7840
Mailing Address - Fax:704-384-7830
Practice Address - Street 1:19485 OLD JETTON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-6582
Practice Address - Country:US
Practice Address - Phone:704-834-1775
Practice Address - Fax:704-384-1776
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2015-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC36092207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89424040Medicaid
NC89424040Medicaid
NC2188083FMedicare ID - Type Unspecified