Healthcare Provider Details

I. General information

NPI: 1457305914
Provider Name (Legal Business Name): GARY J PRYOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 38TH AVE N
ST PETERSBURG FL
33710-1629
US

IV. Provider business mailing address

422 HERMOSITA DR
ST PETE BEACH FL
33706-2806
US

V. Phone/Fax

Practice location:
  • Phone: 727-341-4870
  • Fax:
Mailing address:
  • Phone: 727-363-0503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME94934
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: