Healthcare Provider Details

I. General information

NPI: 1184760902
Provider Name (Legal Business Name): WILLIAM BENJAMIN PRYATEL JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S. COLUMBIA RD
GRAND FORKS ND
58201
US

IV. Provider business mailing address

2401 DEMERS AVE
GRAND FORKS ND
58201
US

V. Phone/Fax

Practice location:
  • Phone: 701-780-5000
  • Fax: 701-253-3999
Mailing address:
  • Phone: 701-780-6468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5827
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: