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General NPI Number Information
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NPI Number | 1194837476
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Entity Type | Individual
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Provider Name | RICHARD EDWIN PRATLEY MD
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 03/10/2021
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Provider Practice Location Address
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Address Line | 2415 N ORANGE AVE SUITE 502
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City | ORLANDO
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State | FL
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Zip | 32804
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Country | US
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Telephone | 407-303-2801
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Fax | 407-303-2805
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Provider Business Mailing Address
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Address Line | 2415 N ORANGE AVE SUITE 502
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City | ORLANDO
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State | FL
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Zip | 32804-5505
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Country | US
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Telephone | 407-303-2801
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Fax | 407-303-2805
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 042-0010757
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | ME110521
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | ME110521
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License Number State | FL
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