Provider Demographics
NPI:1033267877
Name:PROUT, BRIAN (CO)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:PROUT
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 LAKE WOODARD DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-3659
Mailing Address - Country:US
Mailing Address - Phone:919-231-6890
Mailing Address - Fax:919-231-3490
Practice Address - Street 1:3224 LAKE WOODARD DR
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3659
Practice Address - Country:US
Practice Address - Phone:919-231-6890
Practice Address - Fax:919-231-3490
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0414LOtherBCBS
NC7704336Medicaid
NC7795148Medicaid
NC7702039Medicaid
NC0414LOtherBCBS
NC7704336Medicaid