Healthcare Provider Details

I. General information

NPI: 1427020718
Provider Name (Legal Business Name): DOUGLAS JAN PRAVDA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9003 SE HAWKS NEST CT
HOBE SOUND FL
33455-8927
US

IV. Provider business mailing address

287 WATCHUNG FRK
WESTFIELD NJ
07090-3816
US

V. Phone/Fax

Practice location:
  • Phone: 908-241-3181
  • Fax: 908-241-1669
Mailing address:
  • Phone: 908-233-7383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number25MB03272500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: