Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | E8402 | TX |
NPI | 1407813645 |
---|---|
Provider Name | Dr. Robert David Cook |
First Address | Charlotte, NC 28260-3725 |
Second Address | Austin, TX 78756-3716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 09/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
168317901 | (05) | TX |
8H4910 | BCBS PROVIDER NUMBER (01) | TX |
C14727 | (02) | TX |