Provider Demographics
NPI:1073597597
Name:PRATT, DAVID S (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:PRATT
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 1:2222 53RD AVE
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-7546
Mailing Address - Country:US
Mailing Address - Phone:563-383-2686
Mailing Address - Fax:563-884-8144
Practice Address - Street 1:2222 53RD AVE
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-7546
Practice Address - Country:US
Practice Address - Phone:563-383-2686
Practice Address - Fax:563-884-8144
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26490207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA026126Medicaid
IA1233346OtherCSA
IA1233346OtherCSA
IA026126Medicaid
IA26126Medicare PIN
IA100001977Medicare PIN