Healthcare Provider Details

I. General information

NPI: 1730164963
Provider Name (Legal Business Name): DAVID V PRATT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 S CEDAR ST SUITE 100
TACOMA WA
98405-2318
US

IV. Provider business mailing address

2202 S CEDAR ST SUITE 100
TACOMA WA
98405-2318
US

V. Phone/Fax

Practice location:
  • Phone: 253-627-2900
  • Fax: 253-627-2941
Mailing address:
  • Phone: 253-627-2900
  • Fax: 253-627-2941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberMD00035555
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: