Provider Demographics
NPI:1679589741
Name:COOK, PETER A JR (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:A
Last Name:COOK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2000 E GREENVILLE ST
Mailing Address - Street 2:SUITE 2600
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1580
Mailing Address - Country:US
Mailing Address - Phone:864-231-2773
Mailing Address - Fax:864-231-2780
Practice Address - Street 1:2000 E GREENVILLE ST
Practice Address - Street 2:SUITE 2600
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1580
Practice Address - Country:US
Practice Address - Phone:864-231-2773
Practice Address - Fax:864-231-2780
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC140948208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00973424OtherRR MEDICARE
SC140948Medicaid
SCP00973424OtherRR MEDICARE
SC7111Medicare PIN
SC1739Medicare ID - Type Unspecified