Active NPI
Carla Rae Proctor, M.D.
- Pediatrics Physician
- Pueblo, CO
National Provider Identifier
1063472173
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 27054
- Practice address
- 3676 Parker Blvd
Pueblo, CO 81008-2212 - Phone
- (719) 553-2204
- Fax
- (719) 553-2222
- NPI assigned
- Mar 23, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 27054 | CO | Primary |
Addresses
Primary practice location
3676 Parker Blvd
Pueblo, CO 81008-2212
Mailing address
PO Box 9000
Pueblo, CO 81008-9000
Phone (719) 553-2200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01270545 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27054 | CO | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365984000000",
"number": "1063472173",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9000",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810089000",
"telephone_number": "719-553-2200",
"fax_number": "719-553-2222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3676 PARKER BLVD",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810082212",
"telephone_number": "719-553-2204",
"fax_number": "719-553-2222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROCTOR",
"first_name": "CARLA",
"middle_name": "RAE",
"name_prefix": "Miss",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-23",
"last_updated": "2013-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CO",
"license": "27054",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01270545",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
- Primary Home Care
- Nichole Pritchett Hilliard
- Janis M. Proal, MASSAGE THERAPIST
- Maritza Proano, M.D.
- Carol Lynn Procell, R.N.
- Professional Associates of Surgical Services Inc.
- Professional Home Health Care, Inc.
- Professional Home Health Care, Inc.
- Jenny Proffer
- Prosthetic & Orthotic Group - Southern Colorado, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.