MEDICARE: DR. JOHN R 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	207N00000X	Dermatology Physician	11685	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E929440282	OTHER	SC	MCR/MCCORMICK OFFICE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962406900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN R COOK M.D.

Provider Business Mailing Address
First Line	:	2110 WOODSIDE EXECUTIVE CT
Second Line	:
City	:	AIKEN
State	:	SC
Zip	:	29803-3809
Country	:	US
Telephone Number	:	803-644-8900
Fax Number	:	803-644-8995

Provider Business Practice Location Address
First Line	:	2110 WOODSIDE EXECUTIVE CT
Second Line	:
City	:	AIKEN
State	:	SC
Zip	:	29803-3809
Country	:	US
Telephone Number	:	803-644-8900
Fax Number	:	803-644-8995

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	08/29/2019

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