Provider Demographics
NPI:1295892149
Name:COKER, TUMAINI RUCKER (MD)
Entity type:Individual
Prefix:
First Name:TUMAINI
Middle Name:RUCKER
Last Name:COKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TUMAINI
Other - Middle Name:JOEL
Other - Last Name:RUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9107 SE 78TH PL
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040
Mailing Address - Country:US
Mailing Address - Phone:310-663-6721
Mailing Address - Fax:
Practice Address - Street 1:9107 SE 78TH PL
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040
Practice Address - Country:US
Practice Address - Phone:310-663-6721
Practice Address - Fax:310-663-6721
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036111712208000000X
CAA81110208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A811100Medicaid
CAA81110OtherPROFESSIONAL LICENSE
IL036111712Medicaid
CAGA244ZMedicare PIN
CAWA81110AMedicare ID - Type Unspecified