Organization
GBT LBA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES COKER (PRESIDENT)
(904) 518-9654
Entity
Organization
Contact information
Practice address
3101 UNIVERSITY BLVD S, SUITE 203, JACKSONVILLE, FL 32216-2790
(904) 518-9654
(904) 724-5770
Mailing address
2895 EGRET CT, NORTH PORT, FL 34287-2369
(904) 518-9654
(904) 724-5770
Taxonomy
Speciality
Code
Description
License number
State
261QP3300X
Pain Clinic/Center
Primary
208VP0014X
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1427002799
NPI
—
Enumeration date
12/03/2014
Last updated
12/03/2014
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