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NPI Code Detail

MEDICARE: RONALD EDWARD PRUITT M.D.

MEDICARE: RONALD EDWARD PRUITT 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
1207RG0100XGastroenterology PhysicianMD0000019680TN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2100001895OTHERTNRAILRAOD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770582140
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONALD EDWARD PRUITT M.D.
Provider Business Mailing Address
First Line : 104 WOODMONT BLVD
Second Line : SUITE LL50
City : NASHVILLE
State : TN
Zip : 37205-2245
Country : US
Telephone Number : 615-386-2361
Fax Number : 615-386-2399
Provider Business Practice Location Address
First Line : 4230 HARDING ROAD
Second Line : SUITE 309 MEDICAL PLAZA WEST
City : NASHVILLE
State : TN
Zip : 37205-2013
Country : US
Telephone Number : 615-383-0165
Fax Number : 615-292-4657
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2005
Last Update Date : 12/16/2015

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Directions to “ RONALD EDWARD PRUITT M.D.” Practice Location

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