Provider Demographics
NPI:1992819957
Name:WARAN, PRAYUK A (MD)
Entity type:Individual
Prefix:
First Name:PRAYUK
Middle Name:A
Last Name:WARAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 N STONE ST STE B
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-0800
Mailing Address - Country:US
Mailing Address - Phone:386-740-4017
Mailing Address - Fax:386-740-4017
Practice Address - Street 1:999 N STONE ST STE B
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-0800
Practice Address - Country:US
Practice Address - Phone:386-740-4017
Practice Address - Fax:386-740-4017
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041051A207V00000X
CAG130667207V00000X
FLME155251207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000080492OtherANTHEM
IN100385540Medicaid
IN000000721936OtherANTHEM TRADITIONAL
IN000000721936OtherANTHEM TRADITIONAL
IN202790AAAMedicare UPIN
IN100385540Medicaid