Healthcare Provider Details

I. General information

NPI: 1427094705
Provider Name (Legal Business Name): CHRISTOPHER S PRUETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 N BALLAS RD 132A
SAINT LOUIS MO
63131-2322
US

IV. Provider business mailing address

PO BOX 11750
SAINT LOUIS MO
63105-0550
US

V. Phone/Fax

Practice location:
  • Phone: 314-995-6999
  • Fax: 314-995-7064
Mailing address:
  • Phone: 314-432-2580
  • Fax: 314-432-0223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2002008093
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: