Provider Demographics
NPI:1043321920
Name:PRIOR, DONALD S (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:S
Last Name:PRIOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-6980
Mailing Address - Country:US
Mailing Address - Phone:662-332-2487
Mailing Address - Fax:662-334-3529
Practice Address - Street 1:1654 S COLORADO ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-7216
Practice Address - Country:US
Practice Address - Phone:662-332-9872
Practice Address - Fax:662-335-3429
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS147562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1527998OtherLOUISIANA MEDICAID
MS00125077Medicaid
LA1527998OtherLOUISIANA MEDICAID
MS300000511Medicare ID - Type Unspecified
MS00125077Medicaid