Provider Demographics
NPI:1174849020
Name:COKER, BRIDGETTE DENISE (MD)
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:DENISE
Last Name:COKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRIDGETTE
Other - Middle Name:DENISE
Other - Last Name:RATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1367
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75483-1367
Mailing Address - Country:US
Mailing Address - Phone:903-885-3181
Mailing Address - Fax:903-885-1329
Practice Address - Street 1:111 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-2138
Practice Address - Country:US
Practice Address - Phone:903-558-1850
Practice Address - Fax:903-885-1329
Is Sole Proprietor?:No
Enumeration Date:2010-04-18
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2621207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX314196201Medicaid
TX314196201Medicaid