Prairie, John

Prairie, John is an individual health care provider with primary practice located at 303 N Clyde Morris Blvd , Daytona Beach FL 32114-2709. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Prairie, John can be contacted via phone (386) 254-2285.

Contact Information

Primary practice address
303 N Clyde Morris Blvd Daytona Beach FL 32114-2709
Phone: (386) 254-2285
Fax: (386) 425-1304
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X ME55364 Florida

Profile Details

NPI number 1861580839
LBN Legal business name Prairie, John
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 11th, 2006
Last updated Apr 5th, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1861580839 NPPES
Florida Other ME55364 STATE MEDICAL LICENSE
Florida MEDICAID 370303700 STATE MEDICAL LICENSE

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