Provider Demographics
NPI:1700847928
Name:DURAND, PRANGNUAN E (DO)
Entity Type:Individual
Prefix:
First Name:PRANGNUAN
Middle Name:E
Last Name:DURAND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 N ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309
Mailing Address - Country:US
Mailing Address - Phone:954-564-7666
Mailing Address - Fax:954-564-8963
Practice Address - Street 1:3511 N ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309
Practice Address - Country:US
Practice Address - Phone:954-564-7666
Practice Address - Fax:954-564-8963
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7273207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G73368Medicare UPIN
57519Medicare ID - Type Unspecified