Provider Demographics
NPI:1205464559
Name:COOK, GARY LOUIS II
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:LOUIS
Last Name:COOK
Suffix:II
Gender:M
Credentials:
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 12053
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23541-0053
Mailing Address - Country:US
Mailing Address - Phone:757-800-7298
Mailing Address - Fax:
Practice Address - Street 1:7533 SEWELLS POINT RD # K322
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-1757
Practice Address - Country:US
Practice Address - Phone:757-800-7298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA171WV0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WV0202XOther Service ProvidersContractorVehicle Modifications