Provider Demographics
NPI:1891804779
Name:PRUETT, THOMAS CARL (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CARL
Last Name:PRUETT
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 1:534 N FORK RD
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-9108
Mailing Address - Country:US
Mailing Address - Phone:307-332-2434
Mailing Address - Fax:
Practice Address - Street 1:2300 ROSE LN
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-2257
Practice Address - Country:US
Practice Address - Phone:307-857-1211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYWY 2930A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine