Individual
PERRY JAKE PROCTOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
245 WINDWARD WAY STE 101, KALISPELL, MT 59901-3385
(406) 756-8488
(406) 758-3234
Mailing address
19600 E ROSS ST, TAHLEQUAH, OK 74464-0545
(539) 234-1000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MED-PHYS-LIC-110556
MT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/18/2019
Last updated
02/19/2024
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