Individual
MR. CONNIE DALE COOK II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
600 E MCDONALD AVE, MAN, WV 25635-1097
(304) 583-6541
(304) 583-6018
Mailing address
1650 MAIN STREET, PINEVILLE, WV 24874-1650
(304) 732-6735
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
626
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810000560
—
WV
Enumeration date
06/08/2005
Last updated
02/11/2010
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