Provider Demographics
NPI:1902882780
Name:PRYOR, CAROYLN JOYCE (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROYLN
Middle Name:JOYCE
Last Name:PRYOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:493 SAINT FRANCOIS ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-5043
Mailing Address - Country:US
Mailing Address - Phone:314-972-9888
Mailing Address - Fax:314-972-9880
Practice Address - Street 1:493 SAINT FRANCOIS ST
Practice Address - Street 2:SUITE 2
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-5043
Practice Address - Country:US
Practice Address - Phone:314-972-9888
Practice Address - Fax:314-972-9880
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5N75174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1902882780Medicare PIN
MO000015273Medicare PIN
MOE43801Medicare UPIN
MO007965273Medicare PIN