Individual
KEITH O COKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
515 CARLTON ST, WAUCHULA, FL 33873-3407
(863) 773-6606
(863) 773-9542
Mailing address
515 CARLTON ST, WAUCHULA, FL 33873-3407
(863) 773-6606
(863) 773-9542
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA2367
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
290003300
—
FL
01
—
P00003493
RAILROAD MEDICARE
—
Enumeration date
03/14/2006
Last updated
08/28/2013
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