Provider Demographics
NPI:1255846382
Name:PROK, DENNIS (PA- C)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:
Last Name:PROK
Suffix:
Gender:M
Credentials:PA- C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:48TH MDG/ RAF LAKENHEATH
Mailing Address - Street 2:UNIT 5115
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09461-5115
Mailing Address - Country:US
Mailing Address - Phone:314-226-8268
Mailing Address - Fax:
Practice Address - Street 1:48TH MDG/ RAF LAKENHEATH
Practice Address - Street 2:UNIT 5115
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09461-5115
Practice Address - Country:US
Practice Address - Phone:314-226-8268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant