Provider Demographics
NPI:1972555720
Name:COOK, DARREN L (DO)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:L
Last Name:COOK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MAGNOLIA AVE SE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-7266
Mailing Address - Country:US
Mailing Address - Phone:850-243-7968
Mailing Address - Fax:
Practice Address - Street 1:131 MAGNOLIA AVE SE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-7266
Practice Address - Country:US
Practice Address - Phone:850-243-7968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5856207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80384OtherBC BS OF FL
FL251330700Medicaid
FL251330700Medicaid
FL80384OtherBC BS OF FL
FL251330700Medicaid