Provider Demographics
NPI:1851361869
Name:MISHRA, PRABIN C (MD)
Entity Type:Individual
Prefix:DR
First Name:PRABIN
Middle Name:C
Last Name:MISHRA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6002 POINTE WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-5531
Mailing Address - Country:US
Mailing Address - Phone:941-792-3937
Mailing Address - Fax:941-792-1089
Practice Address - Street 1:21275 OLEAN BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6703
Practice Address - Country:US
Practice Address - Phone:941-625-1325
Practice Address - Fax:941-625-0131
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2021-04-08
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Provider Licenses
StateLicense IDTaxonomies
FLME82698207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277112800Medicaid
FLG42156Medicare UPIN
FLU5189TMedicare PIN