Individual
KENNETH C PRATHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
700 W GROVE ST, EL DORADO, AR 71730-4416
(870) 863-2000
Mailing address
5220 BELFORT RD, ATTEN: JULIE KAYE, JACKSONVILLE, FL 32256-6017
(904) 446-3737
(904) 446-3013
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
C5928
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106158001
—
AR
01
—
54158
BLUE CROSS
AR
Enumeration date
03/08/2006
Last updated
01/27/2016
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