Individual
GARY L PRAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1318 MAIN ST, LAFAYETTE, IN 47901-1550
(765) 742-5254
(765) 742-4991
Mailing address
PO BOX 4699, LAFAYETTE, IN 47903-4699
(765) 449-2732
(765) 449-1196
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01026342A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000107537
ANTHEM PROVIDER NUMBER
IN
05
—
100231570
—
IN
Enumeration date
03/14/2006
Last updated
03/23/2021
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