Individual
ANDREW L PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
311 MAPLETON AVE, BOULDER, CO 80304-3979
(303) 544-5700
(303) 544-5710
Mailing address
345 MAXWELL AVE, BOULDER, CO 80304-3972
(303) 544-5783
(303) 441-2388
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
178
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07178007
—
CO
Enumeration date
11/18/2005
Last updated
01/23/2013
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