Individual
BRIAN T. PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1500 WALLACE BLVD, AMARILLO, TX 79106-1794
(806) 212-4673
(806) 352-8890
Mailing address
PO BOX 840048, DALLAS, TX 75284-0048
(806) 212-4673
(806) 352-8890
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
G1161
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
137142911
—
TX
01
—
269051YNR6
MEDICARE
TX
Enumeration date
07/19/2006
Last updated
10/28/2019
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