# MATTHEW PROCTOR MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164611943
- **Authorized official:** TAMMY PROCTOR (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (254) 559-5140

## Contact information

- **Practice address:** 101 S HARTFORD ST, SUITE B, BRECKENRIDGE, TX 76424-4711
- **Practice address phone:** (254) 559-1595
- **Mailing address:** 101 S HARTFORD ST \# B, BRECKENRIDGE, TX 76424-4711
- **Mailing address phone:** (254) 559-1595

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | L3209 | TX | Yes |

## Other

- **Enumeration date:** 10/17/2007
- **Last updated:** 11/30/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0071KH | BCBS | TX |