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NPI Code Detail

MEDICARE: DR. RICHARD J PRY MD

MEDICARE: DR. RICHARD J PRY MD
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
12085R0202XDiagnostic Radiology PhysicianME0050452FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00318900OTHERFLRR MEDICARE FRL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
307379OTHERFLBCBS OF FLORIDA

General Provider Information

NPI Number : 1174577266
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD J PRY MD
Provider Business Mailing Address
First Line : 8791 CONFERENCE DR
Second Line : SUITE 1
City : FORT MYERS
State : FL
Zip : 33919-5822
Country : US
Telephone Number : 239-938-3506
Fax Number :
Provider Business Practice Location Address
First Line : 63 BARKLEY CIR
Second Line : STE. 100 & 101
City : FORT MYERS
State : FL
Zip : 33907-4514
Country : US
Telephone Number : 239-938-3500
Fax Number : 239-278-0588
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2006
Last Update Date : 04/09/2014

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