Pruitt, Roger Devern

Pruitt, Roger Devern is an individual health care provider with primary practice located at 180 Joe Wimberley Blvd Ste 102, Wimberley TX 78676-6083. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Adolescent Medicine, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Pediatrics is his primary health care specialty. Pruitt, Roger Devern can be contacted via phone (512) 847-7700.

Contact Information

Primary practice address
180 Joe Wimberley Blvd Ste 102 Wimberley TX 78676-6083
Phone: (512) 847-7700
Fax: (512) 847-7701
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Adolescent Medicine 2080A0000X L1706 Texas
Allopathic & Osteopathic Physicians / Pediatrics 208000000X L1706 Texas

Profile Details

NPI number 1932104353
LBN Legal business name Pruitt, Roger Devern
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 14th, 2005
Last updated Feb 9th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1932104353 NPPES
Texas Other 7061167 AETNA
Texas Other 0085HZ AETNA
Texas MEDICAID 157905401 AETNA

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