Provider Demographics
NPI:1386886943
Name:PRUCZ, RONI BENJAMIN (MD)
Entity type:Individual
Prefix:DR
First Name:RONI
Middle Name:BENJAMIN
Last Name:PRUCZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9250 N 3RD ST STE 1003
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2402
Mailing Address - Country:US
Mailing Address - Phone:602-331-7811
Mailing Address - Fax:602-331-5886
Practice Address - Street 1:9250 N 3RD ST STE 1003
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2402
Practice Address - Country:US
Practice Address - Phone:602-331-7811
Practice Address - Fax:602-331-5886
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-29
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ529652082S0105X, 2086S0122X, 208200000X, 2082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck