Provider Demographics
NPI:1285647610
Name:PRAGER, ALLEN B (DPM)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:B
Last Name:PRAGER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3771 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-4436
Mailing Address - Country:US
Mailing Address - Phone:323-734-8289
Mailing Address - Fax:323-734-8298
Practice Address - Street 1:3771 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-4436
Practice Address - Country:US
Practice Address - Phone:323-734-8289
Practice Address - Fax:323-734-8298
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1745213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E17451Medicaid
CA000E17451Medicaid
CAE1745Medicare PIN