Individual
DR. JON DAVIS PRUETT
Active
Individual
DR. JON DAVIS PRUETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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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