Provider Demographics
NPI:1144292913
Name:MCPHAIL-PRUITT, MONICA LYNN (MD)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:LYNN
Last Name:MCPHAIL-PRUITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2401 FRIST BLVD
Mailing Address - Street 2:#7, 9 & 10
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4800
Mailing Address - Country:US
Mailing Address - Phone:772-466-0088
Mailing Address - Fax:772-460-8555
Practice Address - Street 1:6903 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-6829
Practice Address - Country:US
Practice Address - Phone:407-298-9900
Practice Address - Fax:407-298-9920
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88069207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267728800Medicaid
FLH72984Medicare UPIN
FL267728800Medicaid
FL71250YMedicare PIN
FL71250ZMedicare PIN