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NPI Code Detail

MEDICARE: DR. HARRELL DOUGLAS PROCTOR M.D.

MEDICARE: DR. HARRELL DOUGLAS PROCTOR M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician10568OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467454769
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HARRELL DOUGLAS PROCTOR M.D.
Provider Business Mailing Address
First Line : 2515 W ELK AVE
Second Line :
City : DUNCAN
State : OK
Zip : 73533-1571
Country : US
Telephone Number : 580-252-6080
Fax Number : 580-470-2933
Provider Business Practice Location Address
First Line : 2515 W ELK AVE
Second Line :
City : DUNCAN
State : OK
Zip : 73533-1571
Country : US
Telephone Number : 580-252-6080
Fax Number : 580-470-2933
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 02/07/2014

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