Provider Demographics
NPI:1316926223
Name:PRUTZMAN, GEORGE W (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:W
Last Name:PRUTZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:689 SIERRA ROSE DR
Mailing Address - Street 2:STE. B
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2060
Mailing Address - Country:US
Mailing Address - Phone:775-786-2100
Mailing Address - Fax:775-786-7706
Practice Address - Street 1:689 SIERRA ROSE DR
Practice Address - Street 2:STE. B
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2060
Practice Address - Country:US
Practice Address - Phone:775-786-2100
Practice Address - Fax:775-786-7706
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2514207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016393Medicaid
CAXPY048680OtherMEDI-CAL
CAXPY048680OtherMEDI-CAL
C96468Medicare UPIN