Provider Demographics
NPI:1336190917
Name:PRUEITT, JOHN LEON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LEON
Last Name:PRUEITT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3626 NE 45TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-5652
Mailing Address - Country:US
Mailing Address - Phone:206-526-0581
Mailing Address - Fax:206-526-0219
Practice Address - Street 1:3626 NE 45TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5652
Practice Address - Country:US
Practice Address - Phone:206-526-0581
Practice Address - Fax:206-526-0219
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD000125622080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine