Provider Demographics
NPI:1700851292
Name:PRATT, CHRISTOPHER C (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:C
Last Name:PRATT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:C
Other - Last Name:PRATT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-332-9977
Practice Address - Street 1:1651 W ROSEDALE
Practice Address - Street 2:SUITE 205
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7437
Practice Address - Country:US
Practice Address - Phone:817-332-9966
Practice Address - Fax:817-332-9977
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5670207LP2900X, 207Q00000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144762504Medicaid
P00640859OtherRAILROAD MEDICARE
TX144762505Medicaid
H21351Medicare UPIN