MEDICARE: DR. JOHN PRUIT 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	207L00000X	Anesthesiology Physician	18572	NV

General Provider Information

NPI Number	:	1972891612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN PRUIT MD

Provider Business Mailing Address
First Line	:	288 JACKALBERRY ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-6318
Country	:	US
Telephone Number	:	682-465-6105
Fax Number	:

Provider Business Practice Location Address
First Line	:	8440 W WARM SPRINGS RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-3624
Country	:	US
Telephone Number	:	682-465-6105
Fax Number	:

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

Provider Enumeration Date	:	07/15/2011
Last Update Date	:	01/09/2024

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Directions to “ DR. JOHN PRUIT MD” Practice Location

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