# BRADLEY D FOURAKER MD LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235311523
- **Authorized official:** BRADLEY D FOURAKER MD (PRESIDENT)
- **Authorized official phone:** (813) 287-2121

## Contact information

- **Practice address:** 4905 W BAY WAY PL, TAMPA, FL 33629-4833
- **Practice address phone:** (813) 287-2121
- **Mailing address:** 4905 W BAY WAY PL, TAMPA, FL 33629-4833
- **Mailing address phone:** (813) 287-2121

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | ME60284 | FL | Yes |

## Other

- **Enumeration date:** 11/29/2007
- **Last updated:** 07/24/2019