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General NPI Number Information
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NPI Number | 1003922055
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Entity Type | Individual
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Provider Name | PETER GERARD PRYDE MD
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Gender | Male
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 202 S PARK ST 4 TOWER
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City | MADISON
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State | WI
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Zip | 53715-1507
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Country | US
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Telephone | 608-267-6676
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Fax |
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Provider Business Mailing Address
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Address Line | 1008 SPAIGHT ST
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City | MADISON
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State | WI
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Zip | 53703-3506
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Country | US
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Telephone | 608-294-9450
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 39817
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License Number State | WI
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