Provider Demographics
NPI:1518092519
Name:JOHN F. PRUDICH, M. D., P. A.
Entity Type:Organization
Organization Name:JOHN F. PRUDICH, M. D., P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:PRUDICH
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:972-562-5800
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3706207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00DE49Medicare ID - Type Unspecified
B25673Medicare UPIN