MEDICARE: CHRISTOPHER C. PRATT D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	K5670	TX
2	207Q00000X	Family Medicine Physician	K5670	TX
3	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	K5670	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00640859	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700851292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER C. PRATT D.O.

Provider Business Mailing Address
First Line	:	PO BOX 961205
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76161-1205
Country	:	US
Telephone Number	:	817-740-8400
Fax Number	:	817-332-9977

Provider Business Practice Location Address
First Line	:	1651 W ROSEDALE
Second Line	:	SUITE 205
City	:	FORT WORTH
State	:	TX
Zip	:	76104-7437
Country	:	US
Telephone Number	:	817-332-9966
Fax Number	:	817-332-9977

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2006
Last Update Date	:	08/27/2013

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Directions to “ CHRISTOPHER C. PRATT D.O.” Practice Location

Language	Start Address	Practice Location

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