MEDICARE: GEORGE W. PRUTZMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	2514	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	XPY048680	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1316926223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE W. PRUTZMAN M.D.

Provider Business Mailing Address
First Line	:	689 SIERRA ROSE DR
Second Line	:	STE. B
City	:	RENO
State	:	NV
Zip	:	89511-2060
Country	:	US
Telephone Number	:	775-786-2100
Fax Number	:	775-786-7706

Provider Business Practice Location Address
First Line	:	689 SIERRA ROSE DR
Second Line	:	STE. B
City	:	RENO
State	:	NV
Zip	:	89511-2060
Country	:	US
Telephone Number	:	775-786-2100
Fax Number	:	775-786-7706

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	10/03/2011

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