Provider Demographics
NPI:1720078637
Name:COKER, CLARINE I (MD)
Entity Type:Individual
Prefix:
First Name:CLARINE
Middle Name:I
Last Name:COKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 RIDGE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4643
Mailing Address - Country:US
Mailing Address - Phone:712-322-5899
Mailing Address - Fax:712-322-5730
Practice Address - Street 1:201 RIDGE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4643
Practice Address - Country:US
Practice Address - Phone:712-322-5899
Practice Address - Fax:712-322-5730
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23346207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3200352Medicaid
IA3200352Medicaid
IAE48734Medicare UPIN