Provider Demographics
NPI:1386278455
Name:PRUEITT, STEVEN J (DO)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:PRUEITT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30TH MEDICAL GROUP, 338 SOUTH DAKOTA
Mailing Address - Street 2:BUILDING 13850
Mailing Address - City:VANDENBERG SPACE FORCE BASE
Mailing Address - State:CA
Mailing Address - Zip Code:93437
Mailing Address - Country:US
Mailing Address - Phone:805-606-1721
Mailing Address - Fax:
Practice Address - Street 1:30TH MEDICAL GROUP, 338 SOUTH DAKOTA
Practice Address - Street 2:BUILDING 13850
Practice Address - City:VANDENBERG SPACE FORCE BASE
Practice Address - State:CA
Practice Address - Zip Code:93437-5300
Practice Address - Country:US
Practice Address - Phone:805-606-1721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2024-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2514207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine