Individual
DR. JASON SCOTT PRUDOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
63600-20
WI
207RP1001X
Pulmonary Disease Physician
Primary
63600-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100042547
—
WI
Enumeration date
04/01/2013
Last updated
03/25/2019
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