Provider Demographics
NPI:1922214378
Name:PRYOR, ZACHARY DUKANE (IDC)
Entity Type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:DUKANE
Last Name:PRYOR
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 SEWELL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-9607
Mailing Address - Country:US
Mailing Address - Phone:910-346-4076
Mailing Address - Fax:910-346-4076
Practice Address - Street 1:1745 10TH STREET
Practice Address - Street 2:BEACH MASTER UNIT TWO
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23459
Practice Address - Country:US
Practice Address - Phone:757-462-7205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman