Provider Demographics
NPI:1790158012
Name:PROHASKA, JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:PROHASKA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 W MORRIS BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-3866
Mailing Address - Country:US
Mailing Address - Phone:423-318-0014
Mailing Address - Fax:423-318-2595
Practice Address - Street 1:1907 W MORRIS BLVD STE G
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-3866
Practice Address - Country:US
Practice Address - Phone:423-318-0014
Practice Address - Fax:423-318-2595
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2016-01634207N00000X, 390200000X
TNMD3678207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program