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General NPI Number Information
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NPI Number | 1588697361
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Entity Type | Individual
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Provider Name | JAMES C PRUITT M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 03/09/2016
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Provider Practice Location Address
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Address Line | 75 S PAGOSA BLVD
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City | PAGOSA SPRINGS
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State | CO
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Zip | 81147-7910
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Country | US
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Telephone | 970-431-4131
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7638
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City | LOVELAND
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State | CO
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Zip | 80537-0638
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Country | US
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Telephone | 970-749-2755
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Fax | 970-259-2431
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 22652
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License Number State | CO
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