Individual
MR. ERRON CODY PROCTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
527 W 3RD ST, KONAWA, OK 74849-1415
(580) 925-3286
(580) 925-2362
Mailing address
PO BOX 358, 527 WEST 3RD ST, KONAWA, OK 74849
(580) 925-3286
(580) 925-9149
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1410
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200072810A
—
OK
Enumeration date
08/05/2006
Last updated
11/19/2021
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