Healthcare Provider Details

I. General information

NPI: 1760407167
Provider Name (Legal Business Name): JONATHAN BRENT PRATHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2949 S UNION ST
OPELOUSAS LA
70570-5740
US

IV. Provider business mailing address

2949 S UNION ST
OPELOUSAS LA
70570-5740
US

V. Phone/Fax

Practice location:
  • Phone: 337-948-9606
  • Fax: 337-948-7003
Mailing address:
  • Phone: 337-948-9606
  • Fax: 337-948-7003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number014301
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: