DR. JON DAVIS PRUETT (NPI# 1023071933) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023071933 |
| Entity Type | Individual |
| Full Name | DR. JON DAVIS PRUETT |
| Credential | M.D. |
| Practice Address |
4340 N Josey Ln Suite 100 Carrollton TX 75010-4602 |
| Practice Telephone | 9724927900 |
| Mailing Telephone | 9724927900 |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2008-04-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | MD.15367R | LA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | BCBS | 8AG440 | 01 |
| Street Address |
4340 N JOSEY LN SUITE 100 |
| City | CARROLLTON |
| State | TX |
| Zip Code | 75010-4602 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578765848 | Fernando Davalos Jr. | Family Medicine | 4340 N Josey Ln, Suite 204, Carrollton, TX 75010-4602 | 2007-05-31 |
| 1184708786 | Trinity Dermatology, P.a. | Dermatology | 4340 N Josey Ln, Suite 100, Carrollton, TX 75010-4602 | 2006-10-24 |
| 1356367106 | Lisa Ann Guidry Pruett | Dermatology | 4340 N Josey Ln, Suite 100, Carrollton, TX 75010-4602 | 2006-07-14 |
| 1720022874 | Mark K Ray | Dermatology | 4340 N Josey Ln, Suite 100, Carrollton, TX 75010-4602 | 2006-06-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043782907 | Timothy C. Pringle Md Pa | Surgery | 4541 N. Josey Lane, Suite 140, Carrollton, TX 75010 | 2018-12-17 |
| 1184106411 | Cindy T Vu | Occupational Therapy Assistant | 1877 Cheyenne, Carrollton, TX 75010 | 2018-09-04 |
| 1639686256 | Little Lantern Hospice LLC | Hospice Care, Community Based | 4541 North Josey Lane, Suite 110-b, Carrollton, TX 75010 | 2018-01-04 |
| 1235681610 | Kahini Shah | Physical Therapist | 1012 W Hebron Pkwy Ste 124, Carrollton, TX 75010 | 2016-11-01 |
| 1881148849 | Wais Azesh | Dentist | 1233 Apache Lake Dr, Carrollton, TX 75010 | 2016-08-08 |
| 1225485055 | Julia Buckelew | Physical Therapist | 4100 Fairway Dr Ste 400, Carrollton, TX 75010 | 2016-05-23 |
| 1811355639 | Fastpass Ucc, Pllc | Clinic/Center | 4228 N Josey Ln Ste 150, Carrollton, TX 75010 | 2016-02-08 |
| 1326404393 | Miaojuan Li | Nurse Practitioner | 4100 Fairway Dr Ste 300, Carrollton, TX 75010 | 2016-01-06 |
| 1912376112 | Envoy Hospice North LLC | Hospice Care, Community Based | 4040 Tx-121, Carrollton, TX 75010 | 2015-09-17 |
| 1932593936 | Lifeway Hospice, LLC | Hospice Care, Community Based | 4040 State Highway 121, Suite 140, Carrollton, TX 75010 | 2015-03-27 |
| Find all providers in zip 75010 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821485434 | Mi Hye Song | Dermatology | 1428 W Hebron Pkwy Ste 120, Carrollton, TX 75010-6347 | 2015-04-21 |
| 1467872002 | Sarah Minka | Dermatology | 157 Clinic Ave Ste 301, Carrollton, GA 30117-4454 | 2014-04-22 |
| 1003180993 | Amanda Hope Champlain | Dermatology | 4340 N Josey Ln Ste 100, Carrollton, TX 75010 | 2012-02-24 |
| 1740801646 | Song Dermatology Pllc | Dermatology | 1428 W Hebron Pkwy Ste 120, Carrollton, TX 75010-6347 | 2020-05-01 |
| 1497121487 | Brittany Baker | Dermatology | 157 Clinic Ave, Suite 301, Carrollton, GA 30117-4454 | 2015-08-13 |
| 1033599840 | Juliet Gibson | Dermatology | 4340 N Josey Ln Ste 100, Carrollton, TX 75010-4604 | 2015-06-05 |
| 1184708786 | Trinity Dermatology, P.a. | Dermatology | 4340 N Josey Ln, Suite 100, Carrollton, TX 75010-4602 | 2006-10-24 |
| 1396767893 | Mary M Feldman | Dermatology | 100 Professional Pl, Suite 110, Carrollton, GA 30117-3874 | 2006-07-24 |
| 1356367106 | Lisa Ann Guidry Pruett | Dermatology | 4340 N Josey Ln, Suite 100, Carrollton, TX 75010-4602 | 2006-07-14 |
| 1477578813 | Thomas H Lamb | Dermatology | 100 Professional Pl, Suite 110, Carrollton, GA 30117-3874 | 2006-07-13 |
| Find all providers in CARROLLTON | ||||
| City | CARROLLTON |
| Zip Code | 75010 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.