Provider Demographics
NPI:1073522660
Name:COKER, SUSAN R (PA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:COKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 LOST ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-1611
Mailing Address - Country:US
Mailing Address - Phone:843-524-8151
Mailing Address - Fax:843-524-1954
Practice Address - Street 1:989 RIBAUT RD STE 210
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5481
Practice Address - Country:US
Practice Address - Phone:843-524-8151
Practice Address - Fax:843-524-1954
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCA904207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology