Individual
MATTHEW DAVID PROCTOR
Active
Individual
MATTHEW DAVID PROCTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
36708
IA
207Y00000X
Otolaryngology Physician
Primary
MD27634
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274607
—
OR
01
—
831523003
REGENCE BLUE CROSS
OR
05
—
8491839
—
WA
01
—
P00436239
RAILROAD MEDICARE
OR
Enumeration date
07/17/2006
Last updated
01/25/2011
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