Pruden, Samuel J
Pruden, Samuel J is an individual health care provider with primary practice located at 989 Governors Ln Ste 260 , Lexington KY 40513-1175. He recently has 4 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatopathology, Allopathic & Osteopathic Physicians / Otolaryngology, Allopathic & Osteopathic Physicians / Plastic Surgery, Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery. Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery is his primary health care specialty. Pruden, Samuel J can be contacted via phone (859) 296-7546.Contact Information
Primary practice address
989 Governors Ln Ste 260
Lexington KY 40513-1175
Phone: (859) 296-7546
Fax: (859) 721-0829
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Allopathic & Osteopathic Physicians / Dermatopathology | 207ND0900X | 34192 | Kentucky |
Allopathic & Osteopathic Physicians / Otolaryngology | 207Y00000X | 34192 | Kentucky |
Allopathic & Osteopathic Physicians / Plastic Surgery | 208200000X | 34192 | Kentucky |
Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery | 207ND0101X | 34192 | Kentucky |
Profile Details
NPI number | 1871593996 |
---|---|
LBN Legal business name | Pruden, Samuel J |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Jul 29th, 2005 |
Last updated | Dec 15th, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1871593996 | NPPES |
Kentucky | Other | 000000823142 | ANTHEM BCBS |
Kentucky | MEDICAID | 64051196 | ANTHEM BCBS |
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