Provider Demographics
NPI:1780612291
Name:COOKE, NELSON ROGER (MD)
Entity type:Individual
Prefix:DR
First Name:NELSON
Middle Name:ROGER
Last Name:COOKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:N.
Other - Middle Name:ROGER
Other - Last Name:COOKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:
Practice Address - Street 1:212 E CENTRAL
Practice Address - Street 2:STE 440
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208
Practice Address - Country:US
Practice Address - Phone:509-252-9602
Practice Address - Fax:509-789-9031
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000146972084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
268OtherGROUP HEALTH
MT35-9723Medicaid
CA4853935Medicaid
ID003168000Medicaid
FL907228400Medicaid
WA1046101Medicaid
KA634OtherBLUE CROSS OF IDAHO
WAAB32999OtherMDC GROUP
WA31509OtherLABOR AND INDUSTRIES
E01203OtherASURIS
CA4853935Medicaid
WAG8869131Medicare PIN
MT35-9723Medicaid
WAG8869131Medicare PIN