Individual
DR. JON DAVIS PRUETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8201 PRESTON RD STE 440, DALLAS, TX 75225-6209
(214) 675-3227
Mailing address
8201 PRESTON RD STE 440, DALLAS, TX 75225-6209
(214) 675-3227
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD.15367R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8AG440
BCBS
TX
Enumeration date
04/11/2006
Last updated
02/17/2022
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