Provider Demographics
NPI:1609559467
Name:COKE, PATRICK JR
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:COKE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:PATRICK
Other - Middle Name:CLIVE
Other - Last Name:COKE
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:BLDG 159, TROUT AVENUE
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340
Mailing Address - Country:US
Mailing Address - Phone:860-694-6483
Mailing Address - Fax:
Practice Address - Street 1:BLDG 159, TROUT AVENUE
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340
Practice Address - Country:US
Practice Address - Phone:860-694-6483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman