Individual
ANDREA PROKOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1200 NW 23RD AVENUE, LEGACY CLINIC GOOD SAMARITAN, PORTLAND, OR 97210
(503) 413-7074
(503) 413-6393
Mailing address
1200 NW 23RD AVENUE, LEGACY CLINIC GOOD SAMARITAN, PORTLAND, OR 97210
(503) 413-7074
(503) 413-6892
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD61055460
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/24/2017
Last updated
09/07/2021
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