Doctor Name: | LYLE PRATHER |
NPI Number: | 1003010430 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LAC |
License Number: | 73 |
Business Practice Address: | 2045 W Victory Way Craig, CO - 816253439 |
Business Phone Number: | 9708242557 |
Business Fax Number: | 9708242412 |
Mailing Address: | 2045 W Victory Way, CRAIG |
State: | CO |
Postal Code: | 816253439 |
Phone Number: | 9708242557 |
Fax Number: | 9708242412 |
NPI Enumeration Date: | 06/11/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 73 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |