Healthcare Provider Details

I. General information

NPI: 1073597597
Provider Name (Legal Business Name): DAVID S PRATT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 53RD AVE
BETTENDORF IA
52722-7546
US

IV. Provider business mailing address

2222 53RD AVE
BETTENDORF IA
52722-7546
US

V. Phone/Fax

Practice location:
  • Phone: 563-383-2686
  • Fax: 563-884-8144
Mailing address:
  • Phone: 563-383-2686
  • Fax: 563-884-8144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number26490
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: