Provider Demographics
NPI:1750577458
Name:JOHN W. COOKE, D.O., P.A
Entity type:Organization
Organization Name:JOHN W. COOKE, D.O., P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-357-3107
Mailing Address - Street 1:633 N BAY ST
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-2937
Mailing Address - Country:US
Mailing Address - Phone:352-357-3107
Mailing Address - Fax:352-357-9971
Practice Address - Street 1:633 N BAY ST
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-2937
Practice Address - Country:US
Practice Address - Phone:352-357-3107
Practice Address - Fax:352-357-9971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4437207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty