Healthcare Provider Details

I. General information

NPI: 1497717987
Provider Name (Legal Business Name): DAVID O COOK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 03/18/2021
Certification Date: 09/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MULBERRY ST SW STE 210
LENOIR NC
28645-5463
US

IV. Provider business mailing address

1139 CARTHAGE ST STE 110-B
SANFORD NC
27330-4111
US

V. Phone/Fax

Practice location:
  • Phone: 828-757-6431
  • Fax: 828-757-6432
Mailing address:
  • Phone: 919-775-7232
  • Fax: 919-775-1731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number29247
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: