=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275457509
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COKER MEDICAL, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2026
-----------------------------------------------------
Last Update Date | 08/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1267 N STEAMBOAT DR STE 3
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72704-7148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-263-0611
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1267 N STEAMBOAT DR STE 3
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72704-7148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-263-0611
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE OWNER
-----------------------------------------------------
Name | LARRY DONNY COKER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 479-263-0611
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------