Individual
MATTHEW DAVID PROCTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1815 E 19TH ST, STE 1, THE DALLES, OR 97058-3385
(541) 298-5563
(541) 298-7746
Mailing address
1815 E 19TH ST, STE 1, THE DALLES, OR 97058-3385
(541) 298-5563
(541) 298-7746
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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