Provider Demographics
NPI:1568541720
Name:COOK, ROSEANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSEANNE
Middle Name:
Last Name:COOK
Suffix:
Gender:F
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 2213
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36702-2213
Mailing Address - Country:US
Mailing Address - Phone:251-746-2197
Mailing Address - Fax:
Practice Address - Street 1:867 CO. RD 59
Practice Address - Street 2:
Practice Address - City:PINEAPPLE
Practice Address - State:AL
Practice Address - Zip Code:36768
Practice Address - Country:US
Practice Address - Phone:251-746-2197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00013033207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC72123Medicare UPIN