Provider Demographics
NPI:1265414262
Name:COOKE, ROBERT GLENN III (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GLENN
Last Name:COOKE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1385
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-1385
Mailing Address - Country:US
Mailing Address - Phone:252-209-3614
Mailing Address - Fax:252-209-0736
Practice Address - Street 1:700 ACADEMY ST S
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3264
Practice Address - Country:US
Practice Address - Phone:252-209-3614
Practice Address - Fax:252-209-0736
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9601583207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1104EOtherBCBS
NC891104EMedicaid
NC891104EMedicaid
NCG04505Medicare UPIN