Provider Demographics
NPI:1174596589
Name:COOK, ROBERT LEWIS (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEWIS
Last Name:COOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-265-0651
Mailing Address - Fax:352-265-0153
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-0651
Practice Address - Fax:352-265-0153
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD059601L174400000X
FLME97889207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277703700Medicaid
PA001605757Medicaid
PA888995D8SMedicare ID - Type Unspecified
PA001605757Medicaid
FL277703700Medicaid