Provider Demographics
NPI:1255160412
Name:PRUITT, BENJAMIN PARKER (MD CLASS OF 2025)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:PARKER
Last Name:PRUITT
Suffix:
Gender:M
Credentials:MD CLASS OF 2025
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MIDLAND ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4132
Mailing Address - Country:US
Mailing Address - Phone:501-940-5216
Mailing Address - Fax:
Practice Address - Street 1:4301 W MARKHAM ST # 550
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-296-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program