Provider Demographics
NPI:1487672663
Name:COOK, JR., VERNON DALE (MD)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:DALE
Last Name:COOK, JR.
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:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-0329
Mailing Address - Fax:502-588-0326
Practice Address - Street 1:401 E CHESTNUT ST
Practice Address - Street 2:STE 401
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5700
Practice Address - Country:US
Practice Address - Phone:502-588-4400
Practice Address - Fax:502-588-4401
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27624207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100332360Medicaid
KY000000047616OtherANTHEM FOUNDATION
KY1049373OtherPASSPORT SPECIALITY - PSC
KY1049364OtherPASPORT PCP - FOUNDATION
KY1049370OtherPASSPORT SPECIALITY - FOUNDATION
KY64276249Medicaid
KY000000062432OtherANTHEM - PSC
KY1049370OtherPASSPORT SPECIALITY - FOUNDATION
IN100332360Medicaid
KY1049370OtherPASSPORT SPECIALITY - FOUNDATION