Provider Demographics
NPI:1750344263
Name:COOK, WILLIAM R (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:COOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:295A MIDLAND PKWY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8104
Mailing Address - Country:US
Mailing Address - Phone:843-851-3800
Mailing Address - Fax:843-851-7787
Practice Address - Street 1:295A MIDLAND PKWY
Practice Address - Street 2:SUITE 140
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8104
Practice Address - Country:US
Practice Address - Phone:843-851-3800
Practice Address - Fax:843-851-7787
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC6106207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC061060Medicaid
SC110073909OtherRAILROAD MEDICARE GA
SC110073909OtherRAILROAD MEDICARE ID
SCD992463101Medicare PIN
SC061060Medicaid