Provider Demographics
NPI:1598783102
Name:COOK, BRIAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:C
Last Name:COOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:215 BEAMAN STREET
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328
Practice Address - Country:US
Practice Address - Phone:910-590-2065
Practice Address - Fax:910-590-2964
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NC2006-011812085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP01016588OtherRAILROAD MEDICARE
NC9149123OtherAETNA
NC1168736OtherGATEWAY HEALTH
NC5904526Medicaid
NCCIGNAOther1960083
NC5904526Medicaid