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Individual

DR. ENAS L PRUITT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
801 E WHITESTONE BLVD STE B, CEDAR PARK, TX 78613-9040
(512) 259-3467
(512) 406-7303
Mailing address
4515 SETON CENTER PKWY, SUITE 215 CREDENTIALING, AUSTIN, TX 78759-5290
(512) 231-5548
(512) 406-6216

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M3701
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
208669603
TX
05
208669604
TX
05
208669605
TX
01
208669608
ARC MEDICAID ROT
TX
01
208669609
ARC MEDICAID TRAVIS
TX
01
334450YKXV
MEDICARE TRAVIS COUNTY
TX
01
334450YKXY
MEDICARE WILLIAMSON COUNTY
TX
01
8CN866
BCBS
TX
Enumeration date
11/07/2006
Last updated
07/21/2022
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