MEDICARE: JOHN M PRATT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	7171	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225086515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN M PRATT MD

Provider Business Mailing Address
First Line	:	5039 BARRIER ISLAND CT
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29466-6933
Country	:	US
Telephone Number	:	843-881-0403
Fax Number	:

Provider Business Practice Location Address
First Line	:	2690 LAKE PARK DR
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9100
Country	:	US
Telephone Number	:	843-764-0992
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	07/08/2007

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