Healthcare Provider Details

I. General information

NPI: 1619183928
Provider Name (Legal Business Name): PETER H PROCTOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 WEST LOOP SOUTH SUITE 225
BELLAIRE TX
77027
US

IV. Provider business mailing address

4518 OAKSHIRE DR
HOUSTON TX
77027-5531
US

V. Phone/Fax

Practice location:
  • Phone: 713-960-1616
  • Fax: 713-960-9307
Mailing address:
  • Phone: 713-960-1616
  • Fax: 713-960-9307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG3056
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG3059
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2083T0002X
TaxonomyMedical Toxicology (Preventive Medicine) Physician
License NumberG3056
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code208U00000X
TaxonomyClinical Pharmacology Physician
License NumberG3056
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: