MEDICARE: MR. DEWAYNE TROY PROCTOR

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
1	332B00000X	Durable Medical Equipment & Medical Supplies	B1208544	MS

General Provider Information

NPI Number	:	1740329259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DEWAYNE TROY PROCTOR

Provider Business Mailing Address
First Line	:	1101 SMITH AVE
Second Line	:
City	:	CLEVELAND
State	:	MS
Zip	:	38732-4059
Country	:	US
Telephone Number	:	662-588-5283
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 SMITH AVE
Second Line	:
City	:	CLEVELAND
State	:	MS
Zip	:	38732-4059
Country	:	US
Telephone Number	:	662-588-5283
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/08/2007

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Directions to “ MR. DEWAYNE TROY PROCTOR ” Practice Location

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