Provider Demographics
NPI:1801014378
Name:PRATER, JOHN FORREST (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FORREST
Last Name:PRATER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3101 E SHEA BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3209
Mailing Address - Country:US
Mailing Address - Phone:602-795-1834
Mailing Address - Fax:602-795-2608
Practice Address - Street 1:3101 E SHEA BLVD STE 220
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3209
Practice Address - Country:US
Practice Address - Phone:602-795-1834
Practice Address - Fax:602-795-2608
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS48792084P0015X
AZ0074092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine