Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 222521 | MA |
Y | 207X00000X | Orthopaedic Surgeon | MD60170138 | WA |
NPI | 1003082017 |
---|---|
Provider Name | Dr. John D Pryor |
First Address | Seattle, WA 98104-1172 |
Second Address | Everett, WA 98201-4261 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2008 |
Last Update Date | 08/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G8893550 | MEDICARE NON-KING CO. (01) | WA |