Healthcare Provider Details

I. General information

NPI: 1285605055
Provider Name (Legal Business Name): BARTON B COOK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 MITYLENE PARK DR
MONTGOMERY AL
36117-3547
US

IV. Provider business mailing address

239 MITYLENE PARK DR
MONTGOMERY AL
36117-3547
US

V. Phone/Fax

Practice location:
  • Phone: 334-612-2111
  • Fax: 334-612-2166
Mailing address:
  • Phone: 334-612-2111
  • Fax: 334-612-2166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number16678
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: