Provider Demographics
NPI:1508844960
Name:PRYOR, JAMES EDWARD (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EDWARD
Last Name:PRYOR
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 1:1809 SW H K DODGEN LOOP
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-1815
Mailing Address - Country:US
Mailing Address - Phone:254-778-5400
Mailing Address - Fax:254-778-5444
Practice Address - Street 1:1809 SW H K DODGEN LOOP
Practice Address - Street 2:SUITE 100
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1815
Practice Address - Country:US
Practice Address - Phone:254-778-5400
Practice Address - Fax:254-778-5444
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9979174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE03419Medicare UPIN
TX8G1755Medicare PIN