Provider Demographics
NPI:1528229812
Name:EDWIN PRATTS PONCE D P M P A
Entity Type:Organization
Organization Name:EDWIN PRATTS PONCE D P M P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATTS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-642-5153
Mailing Address - Street 1:3051 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1257
Mailing Address - Country:US
Mailing Address - Phone:305-642-5153
Mailing Address - Fax:
Practice Address - Street 1:3051 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1257
Practice Address - Country:US
Practice Address - Phone:305-642-5153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL893Medicare PIN