Provider Demographics
NPI:1942382692
Name:PRATER, DEAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:R
Last Name:PRATER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1400 S DOBSON ROAD
Mailing Address - Street 2:ATTN AMANDA GUMP/HOSPITALIST
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202
Mailing Address - Country:US
Mailing Address - Phone:480-412-6788
Mailing Address - Fax:480-412-6848
Practice Address - Street 1:1400 S DOBSON ROAD
Practice Address - Street 2:ATTN AMANDA GUMP/HOSPITALIST
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202
Practice Address - Country:US
Practice Address - Phone:480-412-6788
Practice Address - Fax:480-412-6848
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2020-09-18
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Provider Licenses
StateLicense IDTaxonomies
AZ34327207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ950776Medicaid
AZZ148884Medicare PIN