Healthcare Provider Details

I. General information

NPI: 1629179247
Provider Name (Legal Business Name): MICHAEL W PRYOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 E MAIN ST
LANDER WY
82520-3491
US

IV. Provider business mailing address

815 E MAIN ST
LANDER WY
82520-3491
US

V. Phone/Fax

Practice location:
  • Phone: 307-332-9720
  • Fax: 307-332-8206
Mailing address:
  • Phone: 307-332-9720
  • Fax: 307-332-8206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2769A
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0518540001
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: