Healthcare Provider Details

I. General information

NPI: 1235127499
Provider Name (Legal Business Name): RICHARD PRAGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 SW 57TH AVE
PINECREST FL
33156-2133
US

IV. Provider business mailing address

8950 SW 57TH AVE
PINECREST FL
33156-2133
US

V. Phone/Fax

Practice location:
  • Phone: 305-322-4116
  • Fax: 305-666-2252
Mailing address:
  • Phone: 305-322-4116
  • Fax: 305-666-2252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME45897
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: