Provider Demographics
NPI:1851327209
Name:PRATHER, IRENE LUISA (MD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:LUISA
Last Name:PRATHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:LUISA
Other - Last Name:VALENZUELA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 477
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:75457-0477
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:506 HWY 37 S
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:TX
Practice Address - Zip Code:75457-6550
Practice Address - Country:US
Practice Address - Phone:903-537-8222
Practice Address - Fax:903-537-8223
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4587207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127802006Medicaid
P00023453OtherMEDICARE RR
TXB26888Medicare UPIN