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NPI Code Detail

MEDICARE: MRS. GRETCHEN R PRATER M.D.

MEDICARE: MRS. GRETCHEN R PRATER 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
1208000000XPediatrics PhysicianH4620TX

General Provider Information

NPI Number : 1811096696
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GRETCHEN R PRATER M.D.
Provider Business Mailing Address
First Line : 2140 FM 157 NORTH
Second Line :
City : MANSFIELD
State : TX
Zip : 76063-4847
Country : US
Telephone Number : 817-453-7702
Fax Number : 817-453-7703
Provider Business Practice Location Address
First Line : 2140 FM 157 NORTH
Second Line :
City : MANSFIELD
State : TX
Zip : 76063-4847
Country : US
Telephone Number : 817-453-7702
Fax Number : 817-453-7703
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2006
Last Update Date : 08/04/2009

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