Provider Demographics
NPI:1174659536
Name:PROKOP, BRADFORD S (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:S
Last Name:PROKOP
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11520 COMPASS POINT DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4926
Mailing Address - Country:US
Mailing Address - Phone:239-437-1297
Mailing Address - Fax:239-437-1297
Practice Address - Street 1:11520 COMPASS POINT DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4926
Practice Address - Country:US
Practice Address - Phone:239-437-1297
Practice Address - Fax:239-437-1297
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 10345207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSB68244Medicare UPIN