Provider Demographics
NPI:1457486680
Name:PRUDICH, JOHN FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FRANCIS
Last Name:PRUDICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 N REDBUD BLVD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-3224
Mailing Address - Country:US
Mailing Address - Phone:972-562-5800
Mailing Address - Fax:972-562-2240
Practice Address - Street 1:1441 N REDBUD BLVD
Practice Address - Street 2:SUITE 121
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-3224
Practice Address - Country:US
Practice Address - Phone:972-562-5800
Practice Address - Fax:972-562-2240
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3706207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B25673Medicare UPIN
00DE49Medicare ID - Type Unspecified