Individual
MR. MATTHEW LUCAS COAKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4000 COAST GUARD BLVD, ISC PORTSMOUTH HSDIV, PORTSMOUTH, VA 23703
(757) 483-8596
Mailing address
401 OAK LAKE WAY APT D, CHESAPEAKE, VA 23320-9386
(712) 292-3095
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
07/20/2006
Last updated
07/08/2007
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