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Individual

LEROY KENNETH COOK JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
890 W FARIS RD, SUITE 330, GREENVILLE, SC 29605-4247
(864) 232-1112
(864) 233-1204
Mailing address
1 INDEPENDENCE PT, SUITE 212, GREENVILLE, SC 29615-4545
(864) 797-6044

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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