Provider Demographics
NPI:1407398472
Name:PRATHER, YACUMB
Entity Type:Individual
Prefix:MR
First Name:YACUMB
Middle Name:
Last Name:PRATHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 LOS ALTOS WAY
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPG
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3276
Mailing Address - Country:US
Mailing Address - Phone:407-613-7866
Mailing Address - Fax:
Practice Address - Street 1:438 LOS ALTOS WAY
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPG
Practice Address - State:FL
Practice Address - Zip Code:32714-3276
Practice Address - Country:US
Practice Address - Phone:407-613-7866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other