Dr. Jack Ridings Pruett , MD
General Practice • Sour Lake, TX
Notice of NPI Deactivation & Inactive Practice Status
According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Jack Pruett has officially deactivated this NPI record and ceased active healthcare practice.
Professional Overview & Biography Verified Profile Summary
Dr. Jack Pruett, MD was a registered General Practice practicing in Sour Lake, TX. Throughout an active medical career spanning 15 years, Dr. Pruett provided care at the practice location at 400 HIGHWAY 105 W until profile deactivation on 2021-06-14.
Practice Location & Contact Primary Location
400 Highway 105 W
Sour Lake, TX 776599513
Specialty Benchmarks & Practice Insights
Comparative analytics for General Practice in Sour Lake, TX
Practicing in Sour Lake, TX (1183 Statewide)
In-Person Office Visits Only
Under CMS Medicare Fee Schedule vs Standard Submitted Charges
Medical Specialties & State Licenses
NUCC Taxonomy Code: 208D00000X
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
Career & Practice History Timeline
Chronological log of verified NPI updates, location relocations, credentials, and registry changes
Record deactivated on June 14, 2021
NPI status registered as active in NPPES database
Registered at 400 HIGHWAY 105 W, SOUR LAKE, TX 776599513 (Tel: 4092874389)
Registered at 400 HIGHWAY 105 W, SOUR LAKE, TX 776599513 (Tel: 4092874389)
Recorded as JACK PRUETT, M.D.
General Practice (License #D-8389 in TX)
First registered as active Individual Practitioner in NPPES Database.
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NPI Administrative Meta
Mailing Address
400 Highway 105 W
Sour Lake, TX 776599513
Phone: 4092874389
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