Provider Demographics
NPI:1629207386
Name:THAKOR, PRATAPJI T (MD)
Entity Type:Individual
Prefix:DR
First Name:PRATAPJI
Middle Name:T
Last Name:THAKOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PRATAPPJI
Other - Middle Name:T
Other - Last Name:THAKOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:602 W UNION AVE STE B
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:AR
Mailing Address - Zip Code:72370-3014
Mailing Address - Country:US
Mailing Address - Phone:870-563-6504
Mailing Address - Fax:870-563-7482
Practice Address - Street 1:602 W UNION AVE STE B
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:AR
Practice Address - Zip Code:72370-3014
Practice Address - Country:US
Practice Address - Phone:870-563-6504
Practice Address - Fax:870-563-7482
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE7673207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR194648001Medicaid