Organization
DERMATOLOGY CENTER OF HICKORY, PA
Active
Organization
DERMATOLOGY CENTER OF HICKORY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY LEE PRUITT M.D. (PRESIDENT)
(828) 328-3500
Entity
Organization
Contact information
Practice address
245 11TH AVE NE, HICKORY, NC 28601-3885
(828) 328-3500
(828) 328-8777
Mailing address
245 11TH AVE NE, HICKORY, NC 28601-3885
(828) 328-3500
(828) 328-8777
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070015170
RR MEDICARE
NC
01
—
69390
BLUE CROSS BLUE SHIELD OF NORTH CAROLINA
NC
Enumeration date
06/30/2010
Last updated
07/05/2011
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