Provider Demographics
NPI:1831147404
Name:PROKES, RANDY JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:JAMES
Last Name:PROKES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:13457 ATLANTIC BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-3293
Mailing Address - Country:US
Mailing Address - Phone:904-221-9110
Mailing Address - Fax:904-220-9110
Practice Address - Street 1:13457 ATLANTIC BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-3293
Practice Address - Country:US
Practice Address - Phone:904-221-9110
Practice Address - Fax:904-220-9110
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2012-10-19
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Provider Licenses
StateLicense IDTaxonomies
FLME45570207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14108VMedicare PIN
D85098Medicare UPIN