Provider Demographics
NPI:1083673685
Name:HARRELL, WILLIAM COKE (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:COKE
Last Name:HARRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2118 WILSHIRE BLVD
Mailing Address - Street 2:#1122
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5704
Mailing Address - Country:US
Mailing Address - Phone:310-315-7922
Mailing Address - Fax:310-315-7933
Practice Address - Street 1:2001 SANTA MONICA BLVD
Practice Address - Street 2:390 WEST
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2102
Practice Address - Country:US
Practice Address - Phone:310-315-7922
Practice Address - Fax:310-315-7933
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64492207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G644921OtherMEDI-CAL
E49727Medicare UPIN
CA00G644921OtherMEDI-CAL