Provider Demographics
NPI:1811096696
Name:PRATER, GRETCHEN R (MD)
Entity type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:R
Last Name:PRATER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 FM 157 NORTH
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4847
Mailing Address - Country:US
Mailing Address - Phone:817-453-7702
Mailing Address - Fax:817-453-7703
Practice Address - Street 1:2140 FM 157 NORTH
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-4847
Practice Address - Country:US
Practice Address - Phone:817-453-7702
Practice Address - Fax:817-453-7703
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4620208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG91014Medicare UPIN