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NPI Code Detail

MEDICARE: MR. DENNIS PROK PA- C

MEDICARE: MR. DENNIS PROK PA- C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1255846382
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DENNIS PROK PA- C
Provider Business Mailing Address
First Line : 48TH MDG/ RAF LAKENHEATH
Second Line : UNIT 5115
City : APO
State : AE
Zip : 09461-5115
Country : US
Telephone Number : 314-226-8268
Fax Number :
Provider Business Practice Location Address
First Line : 2000 STEIN DR
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37421-1690
Country : US
Telephone Number : 423-648-8480
Fax Number : 423-648-8481
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2017
Last Update Date : 12/02/2025

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Directions to “ MR. DENNIS PROK PA- C” Practice Location

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