Provider Demographics
NPI:1750316386
Name:COOK, LEWIS LEE JR (MD)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:LEE
Last Name:COOK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34958-0155
Mailing Address - Country:US
Mailing Address - Phone:772-419-8365
Mailing Address - Fax:772-419-8041
Practice Address - Street 1:1203 NW SPRUCE RIDGE DR
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-9517
Practice Address - Country:US
Practice Address - Phone:772-419-8365
Practice Address - Fax:772-419-8041
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME91879207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271573200Medicaid
FL271573200Medicaid
FL52268UMedicare PIN