Provider Demographics
NPI:1659604205
Name:MRAZ, JOHN P (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:MRAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 UHLMAN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:PA
Mailing Address - Zip Code:16415-2116
Mailing Address - Country:US
Mailing Address - Phone:814-838-1711
Mailing Address - Fax:814-833-5988
Practice Address - Street 1:4950 TRAMARLAC LN
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-1326
Practice Address - Country:US
Practice Address - Phone:814-838-1711
Practice Address - Fax:814-833-5988
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD010067E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology