Basic Information
| Provider Information | |||||||||
| NPI: | 1487670717 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRIOR | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1333 W 5TH ST, STE 110 | ||||||||
| Address2: | |||||||||
| City: | SHERIDAN | ||||||||
| State: | WY | ||||||||
| PostalCode: | 828012752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076752650 | ||||||||
| FaxNumber: | 3077562651 | ||||||||
| Practice Location | |||||||||
| Address1: | 61 S GOULD ST | ||||||||
| Address2: | |||||||||
| City: | SHERIDAN | ||||||||
| State: | WY | ||||||||
| PostalCode: | 828016304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076752690 | ||||||||
| FaxNumber: | 3076752691 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 10/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 43744 | CO | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 9784A | WY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QS0010X | 43744 | CO | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207QS0010X | 9784A | WY | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00479748 | 01 | CO | RAILROAD MEDICARE | OTHER |