Doctor Name: | DR. ROGER DEVERN PRUITT |
NPI Number: | 1932104353 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | L1706 |
Business Practice Address: | 180 Joe Wimberley Blvd Ste 102 Wimberley, TX - 786766083 |
Business Phone Number: | 5128477700 |
Business Fax Number: | 5128477701 |
Mailing Address: | 180 Joe Wimberley Blvd, Ste 102 WIMBERLEY |
State: | TX |
Postal Code: | 786766083 |
Phone Number: | 5128477700 |
Fax Number: | 5128477701 |
NPI Enumeration Date: | 06/14/2005 |
NPI Last Update Date: | 11/19/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2080A0000X |
License Number: | L1706 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Pediatrics |
Taxonomy Specialization: | Adolescent Medicine |
Taxonomy Definition: | A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |