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General NPI Number Information
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NPI Number | 1760407167
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Entity Type | Individual
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Provider Name | JONATHAN BRENT PRATHER M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 09/19/2019
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Provider Practice Location Address
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Address Line | 2949 S UNION ST
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City | OPELOUSAS
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State | LA
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Zip | 70570-5740
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Country | US
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Telephone | 337-948-9606
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Fax | 337-948-7003
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Provider Business Mailing Address
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Address Line | 2949 S UNION ST
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City | OPELOUSAS
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State | LA
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Zip | 70570-5740
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Country | US
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Telephone | 337-948-9606
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Fax | 337-948-7003
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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 | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 014301
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License Number State | LA
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