MEDICARE: DAVID W PRUITT MD

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	208100000X	Physical Medicine & Rehabilitation Physician	35.086193	OH
2	2081P0010X	Pediatric Rehabilitation Medicine Physician	35.086193	OH

General Provider Information

NPI Number	:	1356421176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID W PRUITT MD

Provider Business Mailing Address
First Line	:	3333 BURNET AVE
Second Line	:	ML 4009
City	:	CINCINNATI
State	:	OH
Zip	:	45229-3039
Country	:	US
Telephone Number	:	513-636-4225
Fax Number	:	513-636-2511

Provider Business Practice Location Address
First Line	:	3333 BURNET AVE
Second Line	:	ML 4009
City	:	CINCINNATI
State	:	OH
Zip	:	45229-3039
Country	:	US
Telephone Number	:	513-636-7480
Fax Number	:	513-636-7360

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	11/20/2015

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Directions to “ DAVID W PRUITT MD” Practice Location

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