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NPI Code Detail

MEDICARE: DAVID JEROME PRYOR

MEDICARE: DAVID JEROME PRYOR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor954444OH

General Provider Information

NPI Number : 1063929362
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID JEROME PRYOR
Provider Business Mailing Address
First Line : 26942 TUNGSTEN RD
Second Line :
City : EUCLID
State : OH
Zip : 44132-2937
Country : US
Telephone Number : 216-225-5262
Fax Number : 216-391-0978
Provider Business Practice Location Address
First Line : 3030 EUCLID AVE STE 312
Second Line :
City : CLEVELAND
State : OH
Zip : 44115-2518
Country : US
Telephone Number : 216-391-0977
Fax Number : 216-391-0978
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2018
Last Update Date : 01/08/2018

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Directions to “ DAVID JEROME PRYOR ” Practice Location

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