Provider Demographics
NPI:1710900923
Name:PRUETT, DAREL DEAN (DO)
Entity Type:Individual
Prefix:DR
First Name:DAREL
Middle Name:DEAN
Last Name:PRUETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1910
Mailing Address - Street 2:
Mailing Address - City:ISLAMORADA
Mailing Address - State:FL
Mailing Address - Zip Code:33036-1910
Mailing Address - Country:US
Mailing Address - Phone:305-296-3334
Mailing Address - Fax:305-664-9777
Practice Address - Street 1:1010 KENNEDY DR
Practice Address - Street 2:SUITE 304
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4134
Practice Address - Country:US
Practice Address - Phone:305-296-3334
Practice Address - Fax:305-664-9777
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 0004525207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology