Provider Demographics
NPI:1093243008
Name:PRYOR, JOSEPH BRIAN
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BRIAN
Last Name:PRYOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF COLORADO- DIVISION OF PCCM
Mailing Address - Street 2:12700 E. 19TH AVENUE, RC2, MS C272
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045
Mailing Address - Country:US
Mailing Address - Phone:303-724-6043
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF COLORADO- DIVISION OF PCCM
Practice Address - Street 2:12700 E. 19TH AVENUE, RC2, MS C272
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045
Practice Address - Country:US
Practice Address - Phone:303-724-6043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2023-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0070333207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine