Healthcare Provider Details

I. General information

NPI: 1225032121
Provider Name (Legal Business Name): DAVID COOKSEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 01/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 E BERT KOUNS LOOP
SHREVEPORT LA
71105-5634
US

IV. Provider business mailing address

1455 E BERT KOUNS LOOP
SHREVEPORT LA
71105-5634
US

V. Phone/Fax

Practice location:
  • Phone: 318-798-4677
  • Fax: 318-798-4417
Mailing address:
  • Phone: 318-798-4677
  • Fax: 318-798-4417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number012189
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: