Individual
DAVID PROKOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
900 BROADWAY, BANGOR, ME 04401-1900
(207) 907-3300
(207) 907-1923
Mailing address
C/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT, PO BOX 7291, LEWISTON, ME 04243-7291
(207) 777-8560
(207) 777-8800
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD16224
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
312700099
—
ME
Enumeration date
07/20/2006
Last updated
02/03/2022
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