Individual
BRADLEY D FOURAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
403 VONDERBURG DR, STE 101, BRANDON, FL 33511-5982
(813) 681-1122
(813) 684-4924
Mailing address
403 VONDERBURG DR, BRANDON, FL 33511-5982
(813) 681-1122
(813) 684-4924
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
ME0060284
FL
207WX0120X
Cornea and External Diseases Specialist Physician
ME60284
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0498749
GHI
NY
01
—
14958
BCBS FORIDA
FL
01
—
1674799
CIGNA
FL
01
—
2439747
AETNA
FL
05
—
370277400
—
FL
01
—
4414165
AETNA
FL
Enumeration date
08/31/2005
Last updated
07/24/2019
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