Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | A62260 | CA |
N | 208600000X | Surgeon | A62260 | CA |
Y | 2086S0102X | Surgical Critical Care | A62260 | CA |
N | 2086S0127X | Trauma Surgeon | A62260 | CA |
NPI | 1184792079 |
---|---|
Provider Name | Dr. Jonathan Pryor |
First Address | Lynwood, CA 90262-3513 |
Second Address | Lynwood, CA 90262-3513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 20/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G87612 | (02) | CA |