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General NPI Number Information
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NPI Number | 1972704872
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Entity Type | Organization
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Legal Business Name | AMY G PROFFER M. D.
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 12/03/2007
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Provider Practice Location Address
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Address Line | 7100 W 9TH AVE
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City | AMARILLO
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State | TX
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Zip | 79106-1704
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Country | US
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Telephone | 806-351-1560
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Fax | 806-351-0343
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Provider Business Mailing Address
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Address Line | PO BOX 50360
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City | AMARILLO
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State | TX
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Zip | 79159-0360
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Country | US
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Telephone | 806-351-1560
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Fax | 806-351-0343
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Authorized Official
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Title or Position | OWNER
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Name | AMY G PROFFER
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Credential | M. D.
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Telephone | 806-351-1560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number | M0872
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License Number State | TX
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