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General NPI Number Information
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NPI Number | 1841511284
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Entity Type | Organization
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Legal Business Name | MANOJ PRAKASH MD PA
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Dates
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Enumeration Date | 06/21/2010
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Last Update Date | 09/01/2010
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Provider Practice Location Address
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Address Line | 2758 US 1 S
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-6343
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Country | US
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Telephone | 904-797-2338
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 860120
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-0120
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Country | US
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Telephone | 904-797-2338
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MANOJ PRAKASH
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Credential | MD
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Telephone | 904-797-2338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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