Provider Demographics
NPI:1881678613
Name:COOK, ALAN ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:ROBERT
Last Name:COOK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 AMERICAN LEGION RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5657
Mailing Address - Country:US
Mailing Address - Phone:757-484-9535
Mailing Address - Fax:757-484-9540
Practice Address - Street 1:108 AMERICAN LEGION RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5657
Practice Address - Country:US
Practice Address - Phone:757-484-9535
Practice Address - Fax:757-484-9540
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000419213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA021337OtherANTHEM
NC8908057Medicaid
VA010331331Medicaid
VA066587OtherANTHEM
NC08057OtherANTHEM
VA021337OtherANTHEM
NC8908057Medicaid