Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 5660 | AZ |
NPI | 1164565131 |
---|---|
Provider Name | Randall C Pruitt |
First Address | Scottsdale, AZ 85262-8909 |
Second Address | Phoenix, AZ 85044-6094 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 08/07/2007 |