=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568740330
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAT PRYOR M D P A
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2011
-----------------------------------------------------
Last Update Date | 07/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7100 OLD MCGREGOR RD
-----------------------------------------------------
City | WACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76712-6120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-776-6426
-----------------------------------------------------
Fax | 254-776-7413
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7100 OLD MCGREGOR RD
-----------------------------------------------------
City | WACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76712-6120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-776-6426
-----------------------------------------------------
Fax | 254-776-7413
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | GAIL PRYOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 254-776-6426
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------