Individual
DR. ROUHOLLAH F PRUEITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 W MAIN ST, LEWISVILLE, TX 75057-3641
(972) 420-1576
Mailing address
PO BOX 201606, DALLAS, TX 75320-1606
(972) 519-1940
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
L9855
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
168848303
—
TX
05
—
168848304
—
TX
01
—
8C0846
BCBS
TX
01
—
P00323510
RAILROAD
TX
Enumeration date
01/12/2006
Last updated
11/05/2012
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