Provider Demographics
NPI:1093152118
Name:LANDON PRYOR MD SC
Entity Type:Organization
Organization Name:LANDON PRYOR MD SC
Other - Org Name:TRANSFORMATIONS PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-977-4403
Mailing Address - Street 1:5995 SPRING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-6481
Mailing Address - Country:US
Mailing Address - Phone:815-977-4403
Mailing Address - Fax:815-977-5796
Practice Address - Street 1:5995 SPRING CREEK RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-6481
Practice Address - Country:US
Practice Address - Phone:815-977-4403
Practice Address - Fax:815-977-5796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-30
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036124349208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL8608Medicare PIN