Provider Demographics
NPI:1679552350
Name:COOKE, LINDA M (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:M
Last Name:COOKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-6884
Mailing Address - Country:US
Mailing Address - Phone:573-248-3900
Mailing Address - Fax:573-248-3902
Practice Address - Street 1:163 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-6884
Practice Address - Country:US
Practice Address - Phone:573-248-3900
Practice Address - Fax:573-248-3902
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004009689207N00000X, 207ND0101X, 207NS0135X, 207NI0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209341403Medicaid
H51641Medicare UPIN
MO209341403Medicaid