Provider Demographics
NPI:1629179247
Name:PRYOR, MICHAEL W (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
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 1:815 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3491
Mailing Address - Country:US
Mailing Address - Phone:307-332-9720
Mailing Address - Fax:307-332-8206
Practice Address - Street 1:815 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3491
Practice Address - Country:US
Practice Address - Phone:307-332-9720
Practice Address - Fax:307-332-8206
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2769A207X00000X
WY0518540001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY0518540001Medicare NSC
C35235Medicare UPIN
301581Medicare ID - Type Unspecified