Healthcare Provider Details

I. General information

NPI: 1659604205
Provider Name (Legal Business Name): JOHN P MRAZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 01/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 TRAMARLAC LN
ERIE PA
16505-1326
US

IV. Provider business mailing address

4601 UHLMAN RD
FAIRVIEW PA
16415-2116
US

V. Phone/Fax

Practice location:
  • Phone: 814-838-1711
  • Fax: 814-833-5988
Mailing address:
  • Phone: 814-838-1711
  • Fax: 814-833-5988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD010067E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: