Healthcare Provider Details

I. General information

NPI: 1649872680
Provider Name (Legal Business Name): PROCTOR PERSONAL MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2517 N WASHINGTON ST
TACOMA WA
98406-5841
US

IV. Provider business mailing address

2517 N WASHINGTON ST
TACOMA WA
98406-5841
US

V. Phone/Fax

Practice location:
  • Phone: 253-759-3586
  • Fax: 253-759-5746
Mailing address:
  • Phone: 253-759-3586
  • Fax: 253-759-5746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LISA V HAMILL
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 253-759-3586