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General NPI Number Information
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NPI Number | 1497287007
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Entity Type | Individual
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Provider Name | DR. JOSEPH WILLIAM PROCTOR
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Gender | Male
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Dates
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Enumeration Date | 04/02/2017
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Last Update Date | 04/02/2017
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Provider Practice Location Address
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Address Line | 210 S RANDOLPH ST
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City | MACOMB
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State | IL
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Zip | 61455-3828
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Country | US
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Telephone | 217-779-6063
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Fax |
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Provider Business Mailing Address
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Address Line | 6482 LAKESHORE VIEW DR
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City | RUSHVILLE
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State | IL
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Zip | 62681-4707
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Country | US
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Telephone | 217-779-6063
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 071005721
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License Number State | IL
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