Individual
MR. JASON LEE PRATHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1100 E 14TH ST, ADA, OK 74820-6915
(580) 310-5315
(580) 332-8361
Mailing address
1200 E BEVERLY ST, ADA, OK 74820-4051
(580) 310-5006
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
AT 206
OK
Other
Enumeration date
04/04/2007
Last updated
07/08/2007
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