Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 01056407A | IN |
Y | 207Q00000X | Family Doctor | 01056407A | IN |
N | 207QA0401X | Family Doctor - Addiction Medicine | 01056407A | IN |
NPI | 1699749770 |
---|---|
Provider Name | Dr. William E Cooke JR. |
First Address | Austin, IN 47102-1303 |
Second Address | Austin, IN 47102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 03/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200392200 | (05) | IN |
200490500A | (05) | IN |
H76101 | (02) | IN |