Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | MT222270 | PA |
NPI | 1013586635 |
---|---|
Provider Name | Dr. Jessica Pryor |
First Address | Philadelphia, PA 19140-5189 |
Second Address | Philadelphia, PA 19140-5189 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2021 |
Last Update Date | 18/06/2021 |