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General NPI Number Information
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NPI Number | 1427020718
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Entity Type | Individual
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Provider Name | DOUGLAS JAN PRAVDA D.O.
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Gender | Male
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Dates
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Enumeration Date | 02/02/2006
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Last Update Date | 05/09/2025
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Provider Practice Location Address
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Address Line | 9003 SE HAWKS NEST CT
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City | HOBE SOUND
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State | FL
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Zip | 33455-8927
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Country | US
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Telephone | 908-241-3181
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Fax | 908-241-1669
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Provider Business Mailing Address
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Address Line | 287 WATCHUNG FRK
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City | WESTFIELD
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State | NJ
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Zip | 07090-3816
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Country | US
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Telephone | 908-233-7383
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 25MB03272500
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License Number State | NJ
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