Provider Demographics
NPI:1124144977
Name:PRATHER, JOHN L
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:PRATHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9002 OHIO RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-1924
Mailing Address - Country:US
Mailing Address - Phone:740-574-0405
Mailing Address - Fax:740-574-0408
Practice Address - Street 1:9002 OHIO RIVER RD
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-1924
Practice Address - Country:US
Practice Address - Phone:740-574-0405
Practice Address - Fax:740-574-0408
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300182721223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2067865Medicaid
OHU23602Medicare UPIN
OH2067865Medicaid