Provider Demographics
NPI:1801014378
Name:PRATER, JOHN FORREST (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FORREST
Last Name:PRATER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1325 SE 47TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-9692
Mailing Address - Country:US
Mailing Address - Phone:239-549-5224
Mailing Address - Fax:239-549-2488
Practice Address - Street 1:1325 SE 47TH ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-9692
Practice Address - Country:US
Practice Address - Phone:239-549-5224
Practice Address - Fax:239-549-2488
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS48792084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine