Healthcare Provider Details

I. General information

NPI: 1518035104
Provider Name (Legal Business Name): EWING COOK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: EWING COOK M.D.

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 03/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 AMBASSADOR CAFFERY PROVINCE BLDG. 14-A
LAFAYETTE LA
70508
US

IV. Provider business mailing address

5000 AMBASSADOR CAFFERY PROVINCE BLDG. 14-A
LAFAYETTE LA
70508
US

V. Phone/Fax

Practice location:
  • Phone: 337-234-7779
  • Fax: 337-235-7246
Mailing address:
  • Phone: 337-234-7779
  • Fax: 337-235-7246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number011080
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: