Provider Demographics
NPI:1396108676
Name:PROKOP, JOHN (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:PROKOP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:416 COLEGATE DR BLDG 3
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-9549
Mailing Address - Country:US
Mailing Address - Phone:740-374-3526
Mailing Address - Fax:740-374-3165
Practice Address - Street 1:805 FARSON ST STE 116
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1000
Practice Address - Country:US
Practice Address - Phone:740-423-3255
Practice Address - Fax:740-423-3236
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-03
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34.013935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty