Provider Demographics
NPI:1568740330
Name:PAT PRYOR M D P A
Entity Type:Organization
Organization Name:PAT PRYOR M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRYOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-776-6426
Mailing Address - Street 1:7100 OLD MCGREGOR RD
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6120
Mailing Address - Country:US
Mailing Address - Phone:254-776-6426
Mailing Address - Fax:254-776-7413
Practice Address - Street 1:7100 OLD MCGREGOR RD
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6120
Practice Address - Country:US
Practice Address - Phone:254-776-6426
Practice Address - Fax:254-776-7413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R850OtherBLUE CROSS BLUE SHIELD
TX115854503Medicaid
TX121854100OtherFIRSTCARE
TX95209OtherSCOTT & WHITE
TX121854100OtherFIRSTCARE