Individual
BRANDON WADE COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1034 MAR WALT DR UNIT 100, FORT WALTON BEACH, FL 32547
(850) 860-2153
(850) 315-9350
Mailing address
PO BOX 740923, ATLANTA, GA 30374-0923
(805) 860-2153
(850) 315-9350
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
51035
KY
207X00000X
Orthopaedic Surgery Physician
Primary
ME139218
FL
207XS0117X
Orthopaedic Surgery of the Spine Physician
51035
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300014045
—
IN
Enumeration date
05/08/2013
Last updated
08/02/2019
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