Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 45685 | AZ |
Y | 207P00000X | Emergency Physician | ME142076 | FL |
N | 207Q00000X | Family Doctor | ME142076 | FL |
N | 207Q00000X | Family Doctor | MT209273 | PA |
NPI | 1013228592 |
---|---|
Provider Name | Dr. James Allen Pruitt |
First Address | Altoona, PA 16601-4810 |
Second Address | Altoona, PA 16601-4810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2010 |
Last Update Date | 18/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
207Q00000X | (05) | PA |