Provider Demographics
NPI:1689602161
Name:COOK, RALPH DUANE (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:DUANE
Last Name:COOK
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 945921
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-5921
Mailing Address - Country:US
Mailing Address - Phone:386-231-4529
Mailing Address - Fax:386-368-8927
Practice Address - Street 1:801 E DIXIE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748
Practice Address - Country:US
Practice Address - Phone:352-742-1171
Practice Address - Fax:352-742-7241
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75508208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL42936AOtherBCBS FL
FL253974800Medicaid
FL42936BOtherBCBS FL
FL42936OtherBCBS FL
FL42936RMedicare PIN
FL42936AOtherBCBS FL
FLG02669Medicare UPIN
FL253974800Medicaid
FL780001920Medicare PIN
FL42936QMedicare PIN
FL42936BOtherBCBS FL
FL780001243Medicare PIN
FL42936Medicare PIN
FL42936YMedicare PIN