Basic Information
| Provider Information | |||||||||
| NPI: | 1831186030 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRATT | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | EARL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9101 LBJ FWY STE 710 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752431912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727925700 | ||||||||
| FaxNumber: | 2145091170 | ||||||||
| Practice Location | |||||||||
| Address1: | 2021 N MACARTHUR BLVD STE 435 | ||||||||
| Address2: | |||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750612219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724459515 | ||||||||
| FaxNumber: | 9724459414 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2005 | ||||||||
| LastUpdateDate: | 10/08/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | C51826 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | P8086 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 879LPH | 01 | TX | BCBS | OTHER | 00C518260 | 05 | CA | MEDICAID | 333711505 | 05 | TX | MEDICAID | P01488180 | 01 | TX | RAILROAD MEDICARE | OTHER | 333711501 | 05 | TX | MEDICAID | 333711503 | 05 | TX | MEDICAID | 8EK561 | 01 | TX | BCBS | OTHER |