Provider Demographics
NPI:1629254461
Name:PRATT, EDWARD G (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:G
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 1:1008 RANCH RD 620 SOUTH, STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-5633
Mailing Address - Country:US
Mailing Address - Phone:512-263-9072
Mailing Address - Fax:512-402-9057
Practice Address - Street 1:1008 RANCH RD 620 SOUTH, STE 200
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-5633
Practice Address - Country:US
Practice Address - Phone:512-263-9072
Practice Address - Fax:512-402-9057
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2613207Q00000X
TXQ6359207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX452201YLCDMedicare PIN