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Individual
LEROY KENNETH COOK JR.
Active
Individual
LEROY KENNETH COOK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
12343
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123431
—
SC
01
—
160041955
RR MEDICARE
SC
01
—
4481880
AETNA
SC
01
—
571004971010
BCBS
SC
Enumeration date
06/27/2006
Last updated
09/06/2013
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