MEDICARE: DR. DOUGLAS ALLEN PRAGER M.D.

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	207R00000X	Internal Medicine Physician	109766	MO
2	207UN0902X	Nuclear Imaging & Therapy Physician	6587	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	109766	OTHER	MO	INACTIVE STATE MEDICAL LICENSE

General Provider Information

NPI Number	:	1780666099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS ALLEN PRAGER M.D.

Provider Business Mailing Address
First Line	:	374 SOUTHSHORE DR
Second Line	:
City	:	LAKE WINNEBAGO
State	:	MO
Zip	:	64034-9447
Country	:	US
Telephone Number	:	808-679-7672
Fax Number	:	913-442-9023

Provider Business Practice Location Address
First Line	:	374 SOUTHSHORE DR
Second Line	:
City	:	LAKE WINNEBAGO
State	:	MO
Zip	:	64034-9447
Country	:	US
Telephone Number	:	808-679-7672
Fax Number	:	913-442-9023

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

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	06/04/2026

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