Provider Demographics
NPI:1992187587
Name:COKER, MARVIN HAROLD
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:HAROLD
Last Name:COKER
Suffix:
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 1:4202 DAHLIA DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43611-2945
Mailing Address - Country:US
Mailing Address - Phone:419-552-8100
Mailing Address - Fax:
Practice Address - Street 1:4202 DAHLIA DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43611-2945
Practice Address - Country:US
Practice Address - Phone:419-552-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program