Provider Demographics
NPI:1639446305
Name:PRAKIT JEERAPAET MD PA
Entity Type:Organization
Organization Name:PRAKIT JEERAPAET MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAKIT
Authorized Official - Middle Name:
Authorized Official - Last Name:JEERAPAET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-685-7714
Mailing Address - Street 1:116 S MONTCLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5322
Mailing Address - Country:US
Mailing Address - Phone:813-685-0113
Mailing Address - Fax:
Practice Address - Street 1:116 S MONTCLAIR AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5322
Practice Address - Country:US
Practice Address - Phone:813-685-0113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-24
Last Update Date:2011-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19900207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD85477Medicare UPIN
FL29809Medicare PIN