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General NPI Number Information
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NPI Number | 1427094705
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Entity Type | Individual
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Provider Name | CHRISTOPHER S PRUETT M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 08/10/2010
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Provider Practice Location Address
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Address Line | 3009 N BALLAS RD 132A
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City | SAINT LOUIS
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State | MO
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Zip | 63131-2322
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Country | US
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Telephone | 314-995-6999
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Fax | 314-995-7064
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Provider Business Mailing Address
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Address Line | PO BOX 11750
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City | SAINT LOUIS
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State | MO
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Zip | 63105-0550
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Country | US
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Telephone | 314-432-2580
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Fax | 314-432-0223
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 2002008093
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License Number State | MO
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