Provider Demographics
NPI:1619184942
Name:CHESTER E. PRUETT, MD, PA
Entity Type:Organization
Organization Name:CHESTER E. PRUETT, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:E
Authorized Official - Last Name:PRUETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-692-0101
Mailing Address - Street 1:3399 MEDICAL DR.
Mailing Address - Street 2:#393
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-0393
Mailing Address - Country:US
Mailing Address - Phone:210-692-0101
Mailing Address - Fax:210-692-7615
Practice Address - Street 1:3399 MEDICAL DR.
Practice Address - Street 2:#393
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-0393
Practice Address - Country:US
Practice Address - Phone:210-692-0101
Practice Address - Fax:210-692-7615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00SL77OtherBCBS
TXG1752OtherSTATE BOARD CERT.
TX00SL77OtherBCBS
TX8F2784Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE # CP
TX00W401Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER