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General NPI Number Information
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NPI Number | 1093152118
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Entity Type | Organization
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Legal Business Name | LANDON PRYOR MD SC
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Dates
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Enumeration Date | 05/30/2013
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 5995 SPRING CREEK RD
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City | ROCKFORD
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State | IL
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Zip | 61114-6481
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Country | US
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Telephone | 815-977-4403
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Fax | 815-977-5796
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Provider Business Mailing Address
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Address Line | 5995 SPRING CREEK RD
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City | ROCKFORD
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State | IL
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Zip | 61114-6481
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Country | US
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Telephone | 815-977-4403
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Fax | 815-977-5796
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Authorized Official
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Title or Position | MANAGER
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Name | MR. SCOTT D CARTER
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Credential |
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Telephone | 815-977-4403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 036124349
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License Number State | IL
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