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Individual
DR. ROGER DEVERN PRUITT
Active
Individual
DR. ROGER DEVERN PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
L1706
TX
2080A0000X
Pediatric Adolescent Medicine Physician
L1706
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0085HZ
BLUE CROSS BLUE SHIELD
TX
05
—
157905401
—
TX
01
—
7061167
AETNA
TX
Enumeration date
06/14/2005
Last updated
02/09/2022
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