Provider Demographics
NPI:1659868909
Name:TRUITT, JAY MICHAEL (MD, PHD, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:MICHAEL
Last Name:TRUITT
Suffix:
Gender:M
Credentials:MD, PHD, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF DERMATOLOGY 3601 4TH STREET STOP 9400
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430-9400
Mailing Address - Country:US
Mailing Address - Phone:806-743-1842
Mailing Address - Fax:806-743-1105
Practice Address - Street 1:DEPARTMENT OF DERMATOLOGY 3601 4TH STREET STOP 9400
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-0001
Practice Address - Country:US
Practice Address - Phone:806-743-1842
Practice Address - Fax:806-743-1105
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-21
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
TX390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program