| Doctor Name: | GORDON TROY PRAIRIE |
| NPI Number: | 1992776991 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | M9250 |
| Business Practice Address: | Family Medicine Clinic Bayne Jones Army Comm Hospital 1585 3rd Street Fort Polk, LA - 71459 |
| Business Phone Number: | 3375313047 |
| Business Fax Number: | 3375313551 |
| Mailing Address: | 5509 Gardner Dr Apt B, FORT POLK |
| State: | LA |
| Postal Code: | 714593435 |
| Phone Number: | 3375373976 |
| Fax Number: | |
| NPI Enumeration Date: | 01/28/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | M9250 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |