Provider Demographics
NPI:1790726941
Name:PRUITT, SCOTT KNOWLES (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:KNOWLES
Last Name:PRUITT
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 W FOREST HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-1625
Mailing Address - Country:US
Mailing Address - Phone:919-684-3942
Mailing Address - Fax:
Practice Address - Street 1:508 FULTON ST
Practice Address - Street 2:DURHAM VA MEDICAL CENTER
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3875
Practice Address - Country:US
Practice Address - Phone:919-684-3942
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97-011132086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCG57552Medicare UPIN