Provider Demographics
NPI:1487763645
Name:PRYOR, NORMAN DALE (MD)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:DALE
Last Name:PRYOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NORMAN
Other - Middle Name:DALE
Other - Last Name:PRYOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:203 ERNESTINE ST
Mailing Address - Street 2:STE A
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3621
Mailing Address - Country:US
Mailing Address - Phone:407-843-6110
Mailing Address - Fax:407-425-1526
Practice Address - Street 1:203 ERNESTINE ST
Practice Address - Street 2:STE A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-3621
Practice Address - Country:US
Practice Address - Phone:407-843-6110
Practice Address - Fax:407-425-1526
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME489302080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology