Provider Demographics
NPI:1245248822
Name:COOK, ROLAND F (MD)
Entity type:Individual
Prefix:
First Name:ROLAND
Middle Name:F
Last Name:COOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 N CEDARS ROAD
Mailing Address - Street 2:
Mailing Address - City:MUNFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36268-7191
Mailing Address - Country:US
Mailing Address - Phone:256-358-4553
Mailing Address - Fax:256-362-1664
Practice Address - Street 1:48 N CEDARS ROAD
Practice Address - Street 2:
Practice Address - City:MUNFORD
Practice Address - State:AL
Practice Address - Zip Code:36268
Practice Address - Country:US
Practice Address - Phone:256-358-4553
Practice Address - Fax:256-358-2002
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9823207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I084121Medicare PIN
ALC73200Medicare UPIN
AL051557301Medicare ID - Type Unspecified