Individual
DR. JERRY L PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
245 11TH AVE NE, HICKORY, NC 28601-3835
(828) 328-3500
(828) 328-8777
Mailing address
1072 X RAY DR, GASTONIA, NC 28054-7488
(704) 671-1094
(704) 671-1095
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
17415
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
69390
BCBS PROVIDER NUMBER
NC
05
—
8909390
—
NC
Enumeration date
05/11/2006
Last updated
06/23/2020
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