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Individual
RICHARD T PRUIKSMA
Active
Individual
RICHARD T PRUIKSMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
04-28209
KS
207Q00000X
Family Medicine Physician
20107
OK
207Q00000X
Family Medicine Physician
Primary
E-0221
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
351793
MEDICARE ID
AR
01
—
E-0221
LICENSE
AR
Enumeration date
06/22/2006
Last updated
07/14/2014
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