| Doctor Name: | MICHAEL CANAAN PRATER |
| NPI Number: | 1982955886 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | DO0000002155 |
| Business Practice Address: | 408 N State Of Franklin Rd Suite 31 Johnson City, TN - 376046089 |
| Business Phone Number: | 4234312477 |
| Business Fax Number: | 4234312478 |
| Mailing Address: | 408 N State Of Franklin Rd, Suite 31 JOHNSON CITY |
| State: | TN |
| Postal Code: | 376046089 |
| Phone Number: | 4234312477 |
| Fax Number: | 4234312478 |
| NPI Enumeration Date: | 10/02/2012 |
| NPI Last Update Date: | 10/02/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | DO0000002155 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |