Provider Demographics
NPI:1912199456
Name:PRATT, DUSTIN ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:ROBERT
Last Name:PRATT
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 1:1001 US HIGHWAY 83 N
Mailing Address - Street 2:
Mailing Address - City:CHILDRESS
Mailing Address - State:TX
Mailing Address - Zip Code:79201-2322
Mailing Address - Country:US
Mailing Address - Phone:940-937-3636
Mailing Address - Fax:940-937-9644
Practice Address - Street 1:1001 HIGHWAY 83 NORTH
Practice Address - Street 2:
Practice Address - City:CHILDRESS
Practice Address - State:TX
Practice Address - Zip Code:79201-1030
Practice Address - Country:US
Practice Address - Phone:940-937-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6834207Q00000X
251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196752301Medicaid
TX8K9940Medicare PIN