MEDICARE: DR. JEFFREY NELSON COOK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	MS09097	MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	180024836	OTHER	MS	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225033590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY NELSON COOK M.D.

Provider Business Mailing Address
First Line	:	2024 15TH ST
Second Line	:	STE 5D
City	:	MERIDIAN
State	:	MS
Zip	:	39301-4130
Country	:	US
Telephone Number	:	601-553-2100
Fax Number	:	601-553-2104

Provider Business Practice Location Address
First Line	:	2024 15TH ST
Second Line	:	STE 5D
City	:	MERIDIAN
State	:	MS
Zip	:	39301-4130
Country	:	US
Telephone Number	:	601-553-2100
Fax Number	:	601-553-2104

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	06/26/2020

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