Provider Demographics
NPI:1063494854
Name:PRATER, JEFFERY (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:
Last Name:PRATER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 719
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-0719
Mailing Address - Country:US
Mailing Address - Phone:606-439-1316
Mailing Address - Fax:606-439-3922
Practice Address - Street 1:271 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-1939
Practice Address - Country:US
Practice Address - Phone:606-439-1316
Practice Address - Fax:606-439-3922
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26516207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64265168Medicaid
KY0281809Medicare PIN
KY0281609Medicare PIN
KY0501425Medicare PIN
KY0059618Medicare PIN
KY00237006Medicare PIN
KYE07417Medicare UPIN
KY64265168Medicaid
KY0281710Medicare PIN
KY0281909Medicare PIN
KY0281509Medicare PIN
KY0281409Medicare PIN
KYK113740Medicare PIN