# RICHARD T PRUIKSMA

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1053357491
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 04-28209 | KS | — |
| 207Q00000X | Family Medicine Physician | 20107 | OK | — |
| 207Q00000X | Family Medicine Physician | E-0221 | AR | Yes |

## Other

- **Enumeration date:** 06/22/2006
- **Last updated:** 07/14/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 351793 | MEDICARE ID | AR |
| 01 | — | E-0221 | LICENSE | AR |