Provider Demographics
NPI:1073621843
Name:PRAZAK, RICHARD ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALLEN
Last Name:PRAZAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 PASADENA AVE S
Mailing Address - Street 2:STE 430
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707
Mailing Address - Country:US
Mailing Address - Phone:727-347-3151
Mailing Address - Fax:727-347-0006
Practice Address - Street 1:1615 PASADENA AVE S
Practice Address - Street 2:STE 430
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707
Practice Address - Country:US
Practice Address - Phone:727-347-3151
Practice Address - Fax:727-347-0006
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME30806207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79151OtherMEDICARE ID-TYPE UNSPECIFIED
FL068717100Medicaid
058671Medicare UPIN