Provider Demographics
NPI:1760407167
Name:PRATHER, JONATHAN BRENT (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:BRENT
Last Name:PRATHER
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 1:2949 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014301207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1301833Medicaid
LA54743Medicare ID - Type Unspecified
LAB65410Medicare UPIN