Provider Demographics
NPI:1366855843
Name:PRUETT, BRANDON SCOTT (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:SCOTT
Last Name:PRUETT
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CCB 4TH FL 1720 2ND AVE SOUTH
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-2050
Mailing Address - Country:US
Mailing Address - Phone:205-934-4108
Mailing Address - Fax:205-975-8950
Practice Address - Street 1:CCB 4TH FL 1720 2ND AVE SOUTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-2050
Practice Address - Country:US
Practice Address - Phone:205-934-4108
Practice Address - Fax:205-975-8950
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALACSC.369452084P0800X
ALMD.369452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry