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General NPI Number Information
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NPI Number | 1992079917
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Entity Type | Organization
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Legal Business Name | KENNETH C. PRATHER, M.D., P.A.
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Dates
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Enumeration Date | 03/08/2012
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Last Update Date | 03/08/2012
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Provider Practice Location Address
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Address Line | 460 W OAK
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City | EL DORADO
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State | AR
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Zip | 71730-8525
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Country | US
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Telephone | 870-864-5490
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Fax | 870-864-5494
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Provider Business Mailing Address
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Address Line | 5500 OAKWOOD DR
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City | EL DORADO
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State | AR
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Zip | 71730-8525
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Country | US
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Telephone | 870-881-4550
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Fax | 870-881-4550
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. KENNETH C PRATHER
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Credential | M.D.
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Telephone | 870-881-4550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | C-5928
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License Number State | AR
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