Provider Demographics
NPI:1568447886
Name:PRYOR, ROBERT E (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
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 1:310 CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-3808
Mailing Address - Country:US
Mailing Address - Phone:276-236-2073
Mailing Address - Fax:
Practice Address - Street 1:199 HOSPITAL DR
Practice Address - Street 2:SUITE 5
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2454
Practice Address - Country:US
Practice Address - Phone:276-236-6136
Practice Address - Fax:276-236-2536
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-043453207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005816718Medicaid
VA006092667Medicaid
VA010027071Medicaid
110007199Medicare PIN
VA006092667Medicaid
VA003355C86Medicare PIN
110006304Medicare ID - Type Unspecified
VA010027071Medicaid