Healthcare Provider Details

I. General information

NPI: 1477532356
Provider Name (Legal Business Name): DAVID M COOK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19485 OLD JETTON RD SUITE 100
CORNELIUS NC
28031-6582
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-834-1775
  • Fax: 704-384-1776
Mailing address:
  • Phone: 704-384-7840
  • Fax: 704-384-7830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36092
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: