Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 14110 | AL |
NPI | 1003801432 |
---|---|
Provider Name | Parks Winfield Pratt III |
First Address | Dothan, AL 36305-1054 |
Second Address | Dothan, AL 36305-1054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 24/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000084921 | (05) | AL |
00530967A | (05) | GA |
372146900 | (05) | FL |
C73924 | (02) | AL |