Provider Demographics
NPI:1316220007
Name:PRUETT, RALPH EDWARD
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:EDWARD
Last Name:PRUETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 W MT. CARMEL RD.
Mailing Address - Street 2:
Mailing Address - City:CANEY
Mailing Address - State:OK
Mailing Address - Zip Code:74533
Mailing Address - Country:US
Mailing Address - Phone:580-889-5788
Mailing Address - Fax:
Practice Address - Street 1:303 E COURT ST.
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525
Practice Address - Country:US
Practice Address - Phone:580-889-3399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management