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Individual
KERRY ANNE SCULLY PROCTOR
Active
Individual
KERRY ANNE SCULLY PROCTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
36695
IA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
5223915-1205
UT
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
MD27633
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8494999
—
OR
01
—
R0000ZBBWZ
MEDICARE GROUP NO
OR
Enumeration date
04/13/2007
Last updated
12/14/2007
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