Provider Demographics
NPI:1902198351
Name:COOK, ROBERTA SPENCER (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:SPENCER
Last Name:COOK
Suffix:
Gender:F
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 278
Mailing Address - Street 2:
Mailing Address - City:BANNER ELK
Mailing Address - State:NC
Mailing Address - Zip Code:28604-0278
Mailing Address - Country:US
Mailing Address - Phone:828-898-6258
Mailing Address - Fax:828-898-6259
Practice Address - Street 1:108 PARK AVE
Practice Address - Street 2:
Practice Address - City:BANNER ELK
Practice Address - State:NC
Practice Address - Zip Code:28604-6604
Practice Address - Country:US
Practice Address - Phone:828-898-6258
Practice Address - Fax:828-898-6259
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96-01582208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice