Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 99-00194 | NC |
N | 207ND0101X | MOHS-Micrographic Surgeon | 99-00194 | NC |
N | 207NS0135X | Procedural Dermatology | 99-00194 | NC |
NPI | 1417030669 |
---|---|
Provider Name | Jonathan Cook |
First Address | Durham, NC 27710-0001 |
Second Address | Durham, NC 27710-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
891188Q | (05) | NC |
G48341 | (02) |