Provider Demographics
NPI:1841430733
Name:PRATER, SUSAN E (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:PRATER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:11724 SOUTH STATE ST
Mailing Address - Street 2:STE 100
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7165
Mailing Address - Country:US
Mailing Address - Phone:801-576-2065
Mailing Address - Fax:801-576-2066
Practice Address - Street 1:11724 SOUTH STATE ST
Practice Address - Street 2:STE 100
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7165
Practice Address - Country:US
Practice Address - Phone:801-576-2065
Practice Address - Fax:801-576-2066
Is Sole Proprietor?:No
Enumeration Date:2009-03-04
Last Update Date:2014-10-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT8008989-1205207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine