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Deactivated NPI 1225041734 Deactivated / Inactive NPI Male Practitioner

Dr. Jack Ridings Pruett , MD

General Practice • Sour Lake, TX

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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.

Registration / Start Date August 14, 2006
NPI Deactivation Date June 14, 2021
Total Practice Duration ~15 Years of Practice (2006 – 2021)

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

Practice Address

400 Highway 105 W

Sour Lake, TX 776599513

Telephone 4092874389
Fax 4092874398

Specialty Benchmarks & Practice Insights

Comparative analytics for General Practice in Sour Lake, TX

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 27.9 Yrs
Regional Practice Density
2 Specialists

Practicing in Sour Lake, TX (1183 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

General Practice Primary Specialty

NUCC Taxonomy Code: 208D00000X

State License TX D-8389

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

7 Historical Events
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NPI Profile Deactivated June 14, 2021

Record deactivated on June 14, 2021

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 400 HIGHWAY 105 W, SOUR LAKE, TX 776599513 (Tel: 4092874389)

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Updated Business Mailing Address July 08, 2007

Registered at 400 HIGHWAY 105 W, SOUR LAKE, TX 776599513 (Tel: 4092874389)

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Provider Name / Credentials Updated July 08, 2007

Recorded as JACK PRUETT, M.D.

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

General Practice (License #D-8389 in TX)

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Initial NPI Registration & Enumeration August 14, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1225041734
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: August 14, 2006
Last Update: July 08, 2007
Deactivation Date: June 14, 2021

Mailing Address

400 Highway 105 W

Sour Lake, TX 776599513

Phone: 4092874389

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.