Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 39817 | WI |
NPI | 1003922055 |
---|---|
Provider Name | Peter Gerard Pryde |
First Address | Madison, WI 53703-3506 |
Second Address | Madison, WI 53715-1507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32451000 | (05) | WI |
F00457 | (02) | WI |