MEDICARE: ROY PRUDEN 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	208000000X	Pediatrics Physician	T1178	TX

General Provider Information

NPI Number	:	1831687367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROY PRUDEN MD

Provider Business Mailing Address
First Line	:	4900 MUELLER BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-3051
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4900 MUELLER BLVD STE 3S.066C
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-3079
Country	:	US
Telephone Number	:	512-324-0165
Fax Number	:

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

Provider Enumeration Date	:	04/30/2018
Last Update Date	:	03/09/2026

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Directions to “ ROY PRUDEN MD” Practice Location

Language	Start Address	Practice Location

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