Bradley D Fouraker MD LLC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

ME60284 Issued in FL

Legal business name

BRADLEY D FOURAKER MD LLC

Practice address

4905 W Bay Way PL
Tampa, FL 33629-4833

Phone

(813) 287-2121

NPI assigned

Nov 29, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bradley D Fouraker, MDNPI 1467445866

Title

President

Phone

(813) 287-2121

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bradley D Fouraker, MD

  • Ophthalmology Physician
  • Brandon, FL
  • NPI 1467445866
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563926400000",
    "number": "1235311523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4905 W BAY WAY PL",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336294833",
            "telephone_number": "813-287-2121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4905 W BAY WAY PL",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336294833",
            "telephone_number": "813-287-2121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRADLEY D FOURAKER MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-29",
        "last_updated": "2019-07-24",
        "status": "A",
        "authorized_official_last_name": "FOURAKER",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-287-2121",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "FL",
            "license": "ME60284",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert P Bradbury, RPH
• Courtney Sandra Braden, LMT
• Phuong Diep Bradford, APRN
• Shelica Anastari Bradford, PA-C
• Michelle Bradham-Cousar, PHD, CRC, LMHC, NCC
• Alayna Nicole Bradley, PA
• Allison Bradley
• Anthony Bradley, M.D.
• Chandler Rose Marie Bradley
• Dawn Elaine Bradley, LCSW

• Ophthalmology Physician in Tampa, FL
• Providers in Tampa, FL by specialty
• Ophthalmology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.