Dewayne Troy Proctor

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

B1208544 Issued in MS

Practice address

1101 Smith Ave
Cleveland, MS 38732-4059

Phone

(662) 588-5283

NPI assigned

Feb 5, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Ida Rae Proctor Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1740329259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 SMITH AVE",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "387324059",
            "telephone_number": "662-588-5283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 SMITH AVE",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "387324059",
            "telephone_number": "662-588-5283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROCTOR",
        "first_name": "DEWAYNE",
        "middle_name": "TROY",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MS",
            "license": "B1208544",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "IDA",
            "last_name": "PROCTOR",
            "middle_name": "RAE",
            "prefix": "MRS.",
            "credential": "MED, CCC-SLP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Susan Prather, CFNP
• Stevenson Prescott
• Mary Elizabeth Prestage, M.A.
• Julie Manning Price, OT
• Prime Care Hospice, Inc.
• Raanne Ray Tindle D.M.D., P.a.
• Wesley W Radicioni
• Robert T Ragan, D.D.S.
• Paul William Rahfield, CRNA
• Trayceea Ray, LCSW

• Durable Medical Equipment & Medical Supplies in Cleveland, MS
• Providers in Cleveland, MS by specialty
• Durable Medical Equipment & Medical Supplies in Mississippi

• 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.

Verify at the official NPI Registry.