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Individual

TODD A PRYOR

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
418 WASHINGTON ST, LAKEVIEW, MI 48850-9806
(989) 352-7211
Mailing address
PO BOX 3567, GRAND RAPIDS, MI 49501-3567
(616) 975-1845
(616) 285-0846

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
5101009393
MI
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
5101009393
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0F71000
BCBSM
MI
05
114517587
MI
01
7000A410180
BCBS
MI
01
P00389049
RR MCR
Enumeration date
07/24/2006
Last updated
09/23/2011
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