Provider Demographics
NPI:1427094705
Name:PRUETT, CHRISTOPHER S (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:S
Last Name:PRUETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 11750
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-0550
Mailing Address - Country:US
Mailing Address - Phone:314-432-2580
Mailing Address - Fax:314-432-0223
Practice Address - Street 1:3009 N BALLAS RD
Practice Address - Street 2:132A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2322
Practice Address - Country:US
Practice Address - Phone:314-995-6999
Practice Address - Fax:314-995-7064
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2002008093208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO43907V43709OtherHEALTHCARE USA PROV#
MO462626OtherHEALTHLINK PROV#
MO205865710Medicaid
MO149044OtherBCBS PROV#
MOP00036769OtherRR MCR INDIV PROV#
MO142452OtherGHP/CMR INDIV PROV#
MO1700551OtherUHC PROV#
MO7737284OtherAETNA PROV#
MOP00036769OtherRR MCR INDIV PROV#
MO462626OtherHEALTHLINK PROV#