Provider Demographics
NPI:1649302100
Name:COOKE, BRIAN K (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:K
Last Name:COOKE
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:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-265-7041
Mailing Address - Fax:352-265-7983
Practice Address - Street 1:2525 CUMBERLAND PKWY SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3915
Practice Address - Country:US
Practice Address - Phone:352-265-7041
Practice Address - Fax:352-265-7983
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1068272084P0800X
MDD651492084P0800X
GA852492084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002445300Medicaid
FLDL589ZMedicare PIN