Matthew Proctor MD PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

L3209 Issued in TX

Legal business name

MATTHEW PROCTOR MD PA

Practice address

101 S Hartford St
Suite B
Breckenridge, TX 76424-4711

Phone

(254) 559-1595

NPI assigned

Oct 17, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tammy Proctor

Title

Credentialing Specialist

Phone

(254) 559-5140

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Matthew Todd Proctor, MD

  • Family Medicine Physician
  • Jacksonville, TX
  • NPI 1164451407
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196380800000",
    "number": "1164611943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 S HARTFORD ST # B",
            "city": "BRECKENRIDGE",
            "state": "TX",
            "postal_code": "764244711",
            "telephone_number": "254-559-1595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 S HARTFORD ST",
            "address_2": "SUITE B",
            "city": "BRECKENRIDGE",
            "state": "TX",
            "postal_code": "764244711",
            "telephone_number": "254-559-1595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTHEW PROCTOR MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-17",
        "last_updated": "2007-11-30",
        "status": "A",
        "authorized_official_last_name": "PROCTOR",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "254-559-5140"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "L3209",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0071KH",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelsey Ann Komechak, NP-C
• Clint Koshy, RPH
• Larry Len Maples, DO
• Masters Chiropractic, P.C.
• Brian Masters, D.C.
• Rebecca Lynn McIntire, APRN, FNP
• Med Care Medical Supply of No.TX Inc
• Barbara Monserrat Medina-Palacios, PA
• Mineral Wells Medical Supply, Inc (Breckenridge Medical Supply)
• Laura Michelle Morales, PTA

• Family Medicine Physician in Breckenridge, TX
• Providers in Breckenridge, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.