Provider Demographics
NPI:1235127499
Name:PRAGER, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:PRAGER
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 1:8950 SW 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2133
Mailing Address - Country:US
Mailing Address - Phone:305-322-4116
Mailing Address - Fax:305-666-2252
Practice Address - Street 1:8950 SW 57TH AVE
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-2133
Practice Address - Country:US
Practice Address - Phone:305-322-4116
Practice Address - Fax:305-666-2252
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45897207RP1001X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372492100Medicaid
FLNE990OtherWELLCARE
FL39129OtherNHP
FL4631617OtherAETNA
FLP00028793OtherRAILROAD MEDICARE
FL200355OtherAVMED
FL96846OtherBCBS FL