MEDICARE: DR. BRIAN C COOK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist
2	2085R0001X	Radiation Oncology Physician	2006-01181	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01016588	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	9149123	OTHER	NC	AETNA
3	1168736	OTHER	NC	GATEWAY HEALTH
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	CIGNA	OTHER	NC	1960083

General Provider Information

NPI Number	:	1598783102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN C COOK MD

Provider Business Mailing Address
First Line	:	2234 COLONIAL BLVD
Second Line	:	ATTN: PAYER CONTRACTING & RELATIONS
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1412
Country	:	US
Telephone Number	:	239-931-7342
Fax Number	:	239-931-7385

Provider Business Practice Location Address
First Line	:	215 BEAMAN STREET
Second Line	:
City	:	CLINTON
State	:	NC
Zip	:	28328
Country	:	US
Telephone Number	:	910-590-2065
Fax Number	:	910-590-2964

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	10/20/2016

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Directions to “ DR. BRIAN C COOK MD” Practice Location

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