Provider Demographics
NPI:1881852309
Name:PRYOR, BRYANT A (MD)
Entity type:Individual
Prefix:DR
First Name:BRYANT
Middle Name:A
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 1:18951 N MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4217
Mailing Address - Country:US
Mailing Address - Phone:281-540-7700
Mailing Address - Fax:
Practice Address - Street 1:18951 N MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4217
Practice Address - Country:US
Practice Address - Phone:281-540-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2016-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11014099A390200000X
IN01068546A208M00000X
TXP9110208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200993000Medicaid
IN000000675337OtherANTHEM PROVIDER NUMBER
TX335964801Medicaid
INP00911299Medicare PIN
IN000000675337OtherANTHEM PROVIDER NUMBER