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General NPI Number Information
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NPI Number | 1710322987
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Entity Type | Organization
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Legal Business Name | H. RUSSELL COOK, P.C.
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Dates
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Enumeration Date | 05/01/2013
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Last Update Date | 12/09/2015
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Provider Practice Location Address
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Address Line | 207 E WATTS ST SUITE 220
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City | ENTERPRISE
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State | AL
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Zip | 36330-1801
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Country | US
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Telephone | 334-393-1056
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Fax | 334-393-6187
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Provider Business Mailing Address
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Address Line | PO BOX 310210
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City | ENTERPRISE
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State | AL
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Zip | 36331-0210
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Country | US
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Telephone | 334-393-1056
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Fax | 334-393-6187
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Authorized Official
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Title or Position | OWNER
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Name | DR. H. RUSSELL COOK
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Credential | D.O.
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Telephone | 334-393-1056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | DO126
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License Number State | AL
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