Provider Demographics
NPI:1396108676
Name:PROKOP, JOHN (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:PROKOP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 E MILLTOWN RD STE 105
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-1276
Mailing Address - Country:US
Mailing Address - Phone:330-345-8060
Mailing Address - Fax:
Practice Address - Street 1:805 FARSON ST STE 116
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1000
Practice Address - Country:US
Practice Address - Phone:740-423-3255
Practice Address - Fax:740-423-3236
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-03
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.013935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty