Individual provider · NPI-1

Bradley D Fouraker, MD

Ophthalmology · Brandon, FL

NPI number1467445866
StatusActive
Last updated in NPPESJul 24, 2019

Details

NPI
1467445866
Entity type
Individual (NPI-1)
Name
Bradley D Fouraker
Credential
MD
Sex
Male
Sole proprietor
No
Enumeration date
Aug 31, 2005
Last updated
Jul 24, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207W00000X OphthalmologyME0060284FLYes
207WX0120X Ophthalmology, Cornea and External Diseases SpecialistME60284FL

Practice location

403 Vonderburg Dr
Ste 101
Brandon, FL 33511-5982

Phone 813-681-1122 · Fax 813-684-4924

Mailing address

403 Vonderburg Dr
Brandon, FL 33511-5982

Phone 813-681-1122 · Fax 813-684-4924

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