Individual
MICHAEL PROCTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4864 JACKSON ST, MONROE, LA 71202-6400
(318) 333-0703
(318) 330-7648
Mailing address
2015 ROSEDOWN DR, MONROE, LA 71201-3084
(318) 355-8874
(318) 330-7648
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
204759
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063223
—
LA
Enumeration date
05/16/2008
Last updated
10/06/2016
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