Provider Demographics
NPI:1306987557
Name:PRUITT, KIRK EDWARD (LSA)
Entity type:Individual
Prefix:MR
First Name:KIRK
Middle Name:EDWARD
Last Name:PRUITT
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:AMERICAN
Other - Middle Name:SURGICAL
Other - Last Name:ASSISTANTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSA
Mailing Address - Street 1:7324 SOUTHWEST FWY STE 1550
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2053
Mailing Address - Country:US
Mailing Address - Phone:713-779-9800
Mailing Address - Fax:713-779-9813
Practice Address - Street 1:7324 SOUTHWEST FWY STE 1550
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2053
Practice Address - Country:US
Practice Address - Phone:713-779-9800
Practice Address - Fax:409-356-5369
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00048246ZC0007X, 246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist