Provider Demographics
NPI:1275580466
Name:PRENZLAUER, STEVEN L (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:L
Last Name:PRENZLAUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4995 N ACACIA LN
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-9262
Mailing Address - Country:US
Mailing Address - Phone:503-896-4986
Mailing Address - Fax:503-224-4494
Practice Address - Street 1:4995 N ACACIA LN
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-9262
Practice Address - Country:US
Practice Address - Phone:503-896-4986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2007-01462084P0800X
VT042.00146742084P0800X
WAMD609818542084P0800X
ORMD1672892084P0800X
NV187852084P0800X
CAG1630512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500687176Medicaid
TX1978082-01Medicaid
OR500687176Medicaid