Individual
EVELYN BARANCO PRYOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-0000
(318) 629-4833
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
053976
GA
207R00000X
Internal Medicine Physician
Primary
326734
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149934368B
—
GA
05
—
1619977592
—
NC
05
—
5905358
—
NC
01
—
P00378172
RAILROAD MEDICARE
NC
05
—
Q0158H
—
SC
Enumeration date
07/21/2005
Last updated
08/17/2023
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