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Individual

DR. VERNON L PRUITT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1108 ROSS CLARK CIRCLE, DOTHAN, AL 36301
(334) 793-5105
Mailing address
1118 ROSS CLARK CIRCLE, ANESTHESIA CONSULTANTS MEDICAL GROUP PC STE 700, DOTHAN, AL 36301
(334) 793-5105
(334) 671-5073

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
00025583
AL
207LP2900X
Pain Medicine (Anesthesiology) Physician
00025583
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
051518440
AL
01
420979327A
GEORGIA MEDICAID
01
51518440
BCBS OF ALABAMA
Enumeration date
01/10/2006
Last updated
09/27/2010
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