Provider Demographics
NPI:1871588327
Name:COAKWELL, MARK R (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:COAKWELL
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 5TH ST BLDG 840
Mailing Address - Street 2:
Mailing Address - City:WRIGHT PATTERSON AFB
Mailing Address - State:OH
Mailing Address - Zip Code:45433-7951
Mailing Address - Country:US
Mailing Address - Phone:937-938-2744
Mailing Address - Fax:
Practice Address - Street 1:2510 5TH ST BLDG 840
Practice Address - Street 2:
Practice Address - City:WRIGHT PATTERSON AFB
Practice Address - State:OH
Practice Address - Zip Code:45433-7951
Practice Address - Country:US
Practice Address - Phone:937-938-2744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 663502083X0100X, 2083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine