Provider Demographics
NPI:1578690475
Name:COOKE, LAWRENCE WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:WILLIAM
Last Name:COOKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LAWRENCE
Other - Middle Name:WILLIAM
Other - Last Name:COOKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:23521 PASEO DE VALENCIA
Mailing Address - Street 2:SUITE B2
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3107
Mailing Address - Country:US
Mailing Address - Phone:949-215-1511
Mailing Address - Fax:949-215-1512
Practice Address - Street 1:24331 EL TORO RD STE 330
Practice Address - Street 2:
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-2754
Practice Address - Country:US
Practice Address - Phone:949-215-1511
Practice Address - Fax:949-215-1512
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71266208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG71266Medicare ID - Type Unspecified
CAG71266Medicare PIN