Healthcare Provider Details

I. General information

NPI: 1760469258
Provider Name (Legal Business Name): SHEPHERD G PRYOR V M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8952 E DESERT COVE AVE SUITE 205
SCOTTSDALE AZ
85260
US

IV. Provider business mailing address

9097 E DESERT COVE AVE SUITE 260
SCOTTSDALE AZ
85260
US

V. Phone/Fax

Practice location:
  • Phone: 480-273-8688
  • Fax: 480-723-8689
Mailing address:
  • Phone: 480-273-8688
  • Fax: 480-273-8689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number33720
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: