Provider Demographics
NPI:1043456023
Name:COKER, LARRY D (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:D
Last Name:COKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3399 BLACK FOREST DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-6541
Mailing Address - Country:US
Mailing Address - Phone:479-757-5056
Mailing Address - Fax:479-757-5057
Practice Address - Street 1:3399 BLACK FOREST DR
Practice Address - Street 2:SUITE 2
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-6541
Practice Address - Country:US
Practice Address - Phone:479-757-5056
Practice Address - Fax:479-757-5057
Is Sole Proprietor?:No
Enumeration Date:2008-12-23
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAR8504207Q00000X
ARE-7705207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine