Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 33720 | AZ |
NPI | 1760469258 |
---|---|
Provider Name | Shepherd G Pryor V |
First Address | Scottsdale, AZ 85260 |
Second Address | Scottsdale, AZ 85260 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2005 |
Last Update Date | 09/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
021655100 | (05) | MN |
H67611 | (02) |