Individual
MATTHEW PROCTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15790 PAUL VEGA MD DR, RADIOLOGY DEPARTMENT, HAMMOND, LA 70403-1434
(985) 230-6700
(985) 230-1528
Mailing address
15790 PAUL VEGA MD DR, RADIOLOGY DEPARTMENT, HAMMOND, LA 70403-1434
(985) 230-6700
(985) 230-1528
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
204214
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1950882
—
LA
Enumeration date
06/18/2009
Last updated
09/24/2015
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