Provider Demographics
NPI:1235616608
Name:TAYLOR, COKER D III
Entity Type:Individual
Prefix:
First Name:COKER
Middle Name:D
Last Name:TAYLOR
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 NORMANDY LN
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-1308
Mailing Address - Country:US
Mailing Address - Phone:609-456-1449
Mailing Address - Fax:
Practice Address - Street 1:48 NORMANDY LN
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1308
Practice Address - Country:US
Practice Address - Phone:609-456-1449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage