Healthcare Provider Details

I. General information

NPI: 1215984455
Provider Name (Legal Business Name): GEORGE LORING PRATT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13504 TREGARON CIR
BELLEVUE NE
68123-3465
US

IV. Provider business mailing address

13504 TREGARON CIR
BELLEVUE NE
68123-3465
US

V. Phone/Fax

Practice location:
  • Phone: 402-293-0036
  • Fax: 402-293-0097
Mailing address:
  • Phone: 402-293-0036
  • Fax: 402-293-0097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number175
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: