Provider Demographics
NPI:1720011323
Name:JONATHAN BRENT PRATHER, M.D., APMC
Entity Type:Organization
Organization Name:JONATHAN BRENT PRATHER, M.D., APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-948-9606
Mailing Address - Street 1:2949 S UNION ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-5740
Mailing Address - Country:US
Mailing Address - Phone:337-948-9606
Mailing Address - Fax:337-948-7003
Practice Address - Street 1:2949 S UNION ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5740
Practice Address - Country:US
Practice Address - Phone:337-948-9606
Practice Address - Fax:337-948-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014301207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1940402Medicaid
LA57038Medicare ID - Type Unspecified