Provider Demographics
NPI:1760469258
Name:PRYOR, SHEPHERD G V (MD)
Entity Type:Individual
Prefix:
First Name:SHEPHERD
Middle Name:G
Last Name:PRYOR
Suffix:V
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:9097 E DESERT COVE AVE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:480-273-8688
Mailing Address - Fax:480-273-8689
Practice Address - Street 1:8952 E DESERT COVE AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260
Practice Address - Country:US
Practice Address - Phone:480-273-8688
Practice Address - Fax:480-723-8689
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2011-09-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ33720207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN021655100Medicaid
H67611Medicare UPIN