Healthcare Provider Details

I. General information

NPI: 1700252400
Provider Name (Legal Business Name): CAMERON JAMES PRATHER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W 38TH ST STE 400
AUSTIN TX
78705-1103
US

IV. Provider business mailing address

801 W 38TH ST STE 400
AUSTIN TX
78705-1103
US

V. Phone/Fax

Practice location:
  • Phone: 512-306-1323
  • Fax: 512-306-1142
Mailing address:
  • Phone: 512-306-1323
  • Fax: 512-306-1142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA10053
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: