Provider Demographics
NPI:1871528547
Name:COOK, J. BRYON (MD)
Entity type:Individual
Prefix:DR
First Name:J.
Middle Name:BRYON
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 1:1043 OAKLAWN DR
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-3339
Mailing Address - Country:US
Mailing Address - Phone:540-825-6263
Mailing Address - Fax:540-825-4911
Practice Address - Street 1:1043 OAKLAWN DR
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3339
Practice Address - Country:US
Practice Address - Phone:540-825-6263
Practice Address - Fax:540-825-4911
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101028805207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6093779Medicaid
VA6093779Medicaid
VA110006387Medicare ID - Type Unspecified