Individual
DR. COZUMEL SOUTHERN PRUETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, MHS
Contact information
Practice address
200 N WOLFE ST, ROOM 3055, BALTIMORE, MD 21287-0011
(410) 955-2467
Mailing address
PO BOX 64316, BALTIMORE, MD 21264-4316
(410) 955-4427
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
P20254
MD
2080P0210X
Pediatric Nephrology Physician
Primary
D67656
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
055174100
—
MD
Enumeration date
01/17/2007
Last updated
03/01/2013
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