Individual
DR. KENNETH ALLAN MOOK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
2614 JEFFERSON HWY, NEW ORLEANS, LA 70121-3828
(504) 291-5100
(504) 291-5125
Mailing address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-4000
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
31321
KY
208100000X
Physical Medicine & Rehabilitation Physician
Primary
335350
LA
208100000X
Physical Medicine & Rehabilitation Physician
88900
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000074661
ANTHEM PROVIDER #
KY
01
—
1102772
PASSPORT
KY
05
—
200179480
—
IN
01
—
2436318000
PASSPORT ADVANTAGE
KY
01
—
61-1086535
TAX ID
KY
05
—
64-313216
—
KY
05
—
64313216
—
KY
Enumeration date
02/14/2006
Last updated
10/30/2023
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