Provider Demographics
NPI:1083677413
Name:PRASTHOFER, EDGAR FRIEDRICH (MD)
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:FRIEDRICH
Last Name:PRASTHOFER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 ENERGY CENTER BLVD STE 804
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-2798
Mailing Address - Country:US
Mailing Address - Phone:205-366-9740
Mailing Address - Fax:
Practice Address - Street 1:1410 MCFARLAND BLVD N
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2459
Practice Address - Country:US
Practice Address - Phone:205-345-8208
Practice Address - Fax:205-345-8209
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42668174400000X
OH35132100207RH0000X
UT9511470-1205207RH0003X, 207RX0202X
ALMD.9260207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No174400000XOther Service ProvidersSpecialist
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0237183Medicaid
COCO40159Medicare PIN
COC73921Medicare UPIN