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General NPI Number Information
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NPI Number | 1164611943
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Entity Type | Organization
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Legal Business Name | MATTHEW PROCTOR MD PA
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 11/30/2007
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Provider Practice Location Address
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Address Line | 101 S HARTFORD ST SUITE B
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City | BRECKENRIDGE
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State | TX
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Zip | 76424-4711
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Country | US
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Telephone | 254-559-1595
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Fax |
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Provider Business Mailing Address
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Address Line | 101 S HARTFORD ST # B
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City | BRECKENRIDGE
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State | TX
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Zip | 76424-4711
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Country | US
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Telephone | 254-559-1595
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | TAMMY PROCTOR
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Credential |
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Telephone | 254-559-5140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | L3209
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License Number State | TX
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