Basic Information
| Provider Information | |||||||||
| NPI: | 1275053415 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRAWER MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2410 NORTHSIDE DR | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337612236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274990351 | ||||||||
| FaxNumber: | 7277813312 | ||||||||
| Practice Location | |||||||||
| Address1: | 5101 BRITTANY DR S | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337151565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7276448216 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | PRAWER | ||||||||
| AuthorizedOfficialFirstName: | ADAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7276448216 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | ME108773 | 01 | FL | MEDICAL LICENSE | OTHER |