MEDICARE: DR. NARA PRAPAN PRAVAT D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician	N2738	TX
2	390200000X	Student in an Organized Health Care Education/Training Program	DO034259	DC
3	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	N2738	TX

General Provider Information

NPI Number	:	1396906673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NARA PRAPAN PRAVAT D.O.

Provider Business Mailing Address
First Line	:	11412 HILLCREST RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-3104
Country	:	US
Telephone Number	:	817-821-5026
Fax Number	:	972-421-1846

Provider Business Practice Location Address
First Line	:	1420 W MOCKINGBIRD LN STE 420
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75247-4973
Country	:	US
Telephone Number	:	214-267-0101
Fax Number	:	214-267-8787

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2008
Last Update Date	:	04/17/2021

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