Individual
PRAYUK A. WARAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
999 N STONE ST STE B, DELAND, FL 32720-0800
(386) 740-4017
(386) 740-4017
Mailing address
999 N STONE ST STE B, DELAND, FL 32720-0800
(386) 740-4017
(386) 740-4017
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
01041051A
IN
207V00000X
Obstetrics & Gynecology Physician
G130667
CA
207V00000X
Obstetrics & Gynecology Physician
Primary
ME155251
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000080492
ANTHEM
IN
01
—
000000721936
ANTHEM TRADITIONAL
IN
05
—
100385540
—
IN
Enumeration date
08/18/2006
Last updated
12/20/2022
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