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1912741919
DERRICK WAYNE PRUITT
TULSA, OK
NPI
1912741919
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2024-06-24
Last Update Date
2024-06-24
Business Address
DERRICK WAYNE PRUITT Medical Student
1111 W 17TH ST
TULSA, OK 74107-1886
Phone number: 918-582-1972
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Mailing Address
DERRICK WAYNE PRUITT Medical Student
5749 E 30TH ST
TULSA, OK 74114-6412
Phone number: 405-609-9114
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