Provider Demographics
NPI:1831459940
Name:PRYOR, MARTIN JAN (DO, MPH)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:JAN
Last Name:PRYOR
Suffix:
Gender:M
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 491
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-0491
Mailing Address - Country:US
Mailing Address - Phone:808-203-7019
Mailing Address - Fax:
Practice Address - Street 1:315 S. OSTEOPATHY STREET
Practice Address - Street 2:ATTN: GME
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-0491
Practice Address - Country:US
Practice Address - Phone:808-203-7019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012033013204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM