Provider Demographics
NPI:1457316556
Name:COKER, RAYMOND K (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:K
Last Name:COKER
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:PO BOX 1901
Mailing Address - Street 2:
Mailing Address - City:STUTTGART
Mailing Address - State:AR
Mailing Address - Zip Code:72160-1901
Mailing Address - Country:US
Mailing Address - Phone:870-673-7211
Mailing Address - Fax:870-672-6823
Practice Address - Street 1:1609 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:STUTTGART
Practice Address - State:AR
Practice Address - Zip Code:72160-3274
Practice Address - Country:US
Practice Address - Phone:870-673-7211
Practice Address - Fax:870-672-6823
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2688207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR136428729Medicaid
AR201478729Medicaid
AR201481729Medicaid
AR201479729Medicaid
AR203673729Medicaid
ARE2688OtherLICENSE
AR201482729Medicaid
AR100907002Medicaid
AR129735729Medicaid
AR141588001Medicaid
AR129734729Medicaid
AR201477729Medicaid
AR043489Medicare Oscar/Certification
AR040072Medicare Oscar/Certification
AR043456Medicare Oscar/Certification
AR5B782Medicare PIN
AR129735729Medicaid
AR129734729Medicaid
AR56965Medicare PIN
ARE2688OtherLICENSE
AR043492Medicare Oscar/Certification
AR5L687Medicare PIN
AR100907002Medicaid
AR048505Medicare Oscar/Certification