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General NPI Number Information
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NPI Number | 1386866051
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Entity Type | Individual
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Provider Name | DWAYNE ROBERT COOK I RT
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Gender | Male
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 03/31/2008
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Provider Practice Location Address
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Address Line | 420 N CENTER DR SUITE 230
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City | NORFOLK
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State | VA
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Zip | 23502-4007
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Country | US
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Telephone | 757-466-1163
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Fax | 757-466-1178
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Provider Business Mailing Address
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Address Line | PO BOX 2145
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City | CHESAPEAKE
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State | VA
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Zip | 23327-2145
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Country | US
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Telephone | 757-466-1163
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Fax | 757-466-1178
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471C3402X
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Taxonomy Name | Radiography Radiologic Technologist
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License Number | 0120002367
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License Number State | VA
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