Provider Demographics
NPI:1700252400
Name:PRATHER, CAMERON JAMES (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CAMERON
Middle Name:JAMES
Last Name:PRATHER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W 38TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1103
Mailing Address - Country:US
Mailing Address - Phone:512-306-1323
Mailing Address - Fax:512-306-1142
Practice Address - Street 1:801 W 38TH ST STE 400
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1103
Practice Address - Country:US
Practice Address - Phone:512-306-1323
Practice Address - Fax:512-306-1142
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10053363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX355601101Medicaid
TX355601101Medicaid