Healthcare Provider Details

I. General information

NPI: 1386612943
Provider Name (Legal Business Name): DONALD DUANE COKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 03/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 SOUTH FOURTH STREET
LEBANON PA
17042-1281
US

IV. Provider business mailing address

229 SOUTH FOURTH STREET
LEBANON PA
17042-1281
US

V. Phone/Fax

Practice location:
  • Phone: 717-270-7908
  • Fax:
Mailing address:
  • Phone: 717-270-7908
  • Fax: 304-373-0497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD426901
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: