Active NPI
Michael Wayne Proctor, MD,FAAFP
- Family Medicine Physician
- Anniston, AL
National Provider Identifier
1598828915
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 00011525
- Practice address
- 1325 Quintard Ave
Anniston, AL 36201-4619 - Phone
- (256) 741-1339
- Fax
- (256) 741-1356
- NPI assigned
- Dec 18, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 00011525 | AL | Primary |
Addresses
Primary practice location
1325 Quintard Ave
Anniston, AL 36201-4619
Mailing address
1325 Quintard Ave
Anniston, AL 36201-4619
Phone (256) 741-1339
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 51509348 | Other | AL | BLUE CROSS BLUE SHIELD |
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
- HHS exclusion list flag
- CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00011525 | AL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Anniston Pathology | Current | Accepting new patients | |
| Inphynet Contracting Services LLC | Past | Accepting new patients |
Locations
400 E 10th St
Anniston, AL 36207
Phone (256) 235-5121
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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- NPI 1073556767
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1598828915",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1325 QUINTARD AVE",
"city": "ANNISTON",
"state": "AL",
"postal_code": "362014619",
"telephone_number": "256-741-1339",
"fax_number": "256-741-1356"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1325 QUINTARD AVE",
"city": "ANNISTON",
"state": "AL",
"postal_code": "362014619",
"telephone_number": "256-741-1339",
"fax_number": "256-741-1356"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROCTOR",
"first_name": "MICHAEL",
"middle_name": "WAYNE",
"credential": "MD,FAAFP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AL",
"license": "00011525",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "51509348",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Anniston, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.