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Individual
RICHARD EDWARD COOKSLEY
Active
Individual
RICHARD EDWARD COOKSLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA00272
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
165878
—
OR
01
—
930087876
RAILROAD MEDICARE
OR
01
—
PA00272
STATE LICENSE
OR
Enumeration date
01/27/2006
Last updated
10/18/2018
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