Provider Demographics
NPI:1992883904
Name:PRANCKUN, CHRISTOPHER J (PAC MPH)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:J
Last Name:PRANCKUN
Suffix:
Gender:M
Credentials:PAC MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120A BUTLER STREET
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407
Mailing Address - Country:US
Mailing Address - Phone:561-659-1510
Mailing Address - Fax:561-659-0495
Practice Address - Street 1:120A BUTLER STREET
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407
Practice Address - Country:US
Practice Address - Phone:561-659-1510
Practice Address - Fax:561-659-0495
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102109207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
U0428YMedicare ID - Type Unspecified
P85241Medicare UPIN