Provider Demographics
NPI:1245329333
Name:COOK, RANDALL G (MD)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:G
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 1:1801 PINE ST 102
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1154
Mailing Address - Country:US
Mailing Address - Phone:334-265-9888
Mailing Address - Fax:334-293-6892
Practice Address - Street 1:1722 PINE ST
Practice Address - Street 2:SUITE 902
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1103
Practice Address - Country:US
Practice Address - Phone:334-265-9888
Practice Address - Fax:334-265-0070
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16958208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL60705Medicare ID - Type Unspecified
ALD57369Medicare UPIN