Provider Demographics
NPI:1497192702
Name:PRUST, STEVEN MICHAEL LUZADER (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MICHAEL LUZADER
Last Name:PRUST
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 1:4881 E GRANT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2704
Mailing Address - Country:US
Mailing Address - Phone:520-318-6035
Mailing Address - Fax:520-795-9953
Practice Address - Street 1:4881 E GRANT RD STE 101
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2704
Practice Address - Country:US
Practice Address - Phone:520-318-6035
Practice Address - Fax:520-795-9953
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ5906207L00000X
AZ54777207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ431698Medicaid
TX371487502OtherCSHCN