Provider Demographics
NPI:1700269123
Name:PRATT, JEAN (DPM)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:PRATT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5213
Mailing Address - Country:US
Mailing Address - Phone:256-547-1631
Mailing Address - Fax:256-547-1632
Practice Address - Street 1:306 S 4TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901
Practice Address - Country:US
Practice Address - Phone:256-547-1631
Practice Address - Fax:256-547-1632
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL339213ES0131X
IL135000882213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty