Provider Demographics
NPI:1215932975
Name:PRATHER, JOSEPH W (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:W
Last Name:PRATHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HELMWOOD PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2975
Mailing Address - Country:US
Mailing Address - Phone:270-763-6363
Mailing Address - Fax:270-763-1247
Practice Address - Street 1:100 HELMWOOD PLAZA DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2975
Practice Address - Country:US
Practice Address - Phone:270-763-6363
Practice Address - Fax:270-763-1247
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2007-12-13
Deactivation Date:2006-04-21
Deactivation Code:
Reactivation Date:2006-04-27
Provider Licenses
StateLicense IDTaxonomies
KY37348207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00485OtherMEDICARE GROUP #
KY00485OtherMEDICARE GROUP #