MEDICARE: HENRY W PRATT P.A.

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	363AM0700X	Medical Physician Assistant	PA 15097	CA
2	363A00000X	Physician Assistant	15097	CA

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	:	1356334056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY W PRATT P.A.

Provider Business Mailing Address
First Line	:	PO BOX 3768
Second Line	:
City	:	MERCED
State	:	CA
Zip	:	95344-3768
Country	:	US
Telephone Number	:	209-725-7149
Fax Number	:	209-726-0134

Provider Business Practice Location Address
First Line	:	3605 HOSPITAL RD
Second Line	:	SUITE M
City	:	ATWATER
State	:	CA
Zip	:	95301-5173
Country	:	US
Telephone Number	:	209-383-5500
Fax Number	:	209-383-6910

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	02/15/2017

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