Active NPI
Joseph Charles Proctor Sr., D.O.
- Emergency Medicine Physician
- Parker, AZ
National Provider Identifier
1790707172
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 3165
- Practice address
- 1200 W Mohave Rd
Parker, AZ 85344-6349 - Phone
- (928) 669-7420
- NPI assigned
- Jul 24, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 3165 | AZ | Primary |
Addresses
Primary practice location
1200 W Mohave Rd
Parker, AZ 85344-6349
Mailing address
3881 Bear Dr
Lake Havasu City, AZ 86406-4374
Phone (928) 505-4945
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)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3165 | CA | MD | Occupational Therapy Assistant |
| 3165 | AZ | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| UC Physicians of Parker Az | Past | Accepting new patients | |
| Emcare Physician Providers, Inc | Emergency Medicine | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Emergency Medicine Physician
- Parker, AZ
- NPI 1821048927
-
- Nurse Practitioner
- Parker, AZ
- NPI 1467698282
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1790707172",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3881 BEAR DR",
"city": "LAKE HAVASU CITY",
"state": "AZ",
"postal_code": "864064374",
"telephone_number": "928-505-4945",
"fax_number": "928-505-3338"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 W MOHAVE RD",
"city": "PARKER",
"state": "AZ",
"postal_code": "853446349",
"telephone_number": "928-669-7420"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROCTOR",
"first_name": "JOSEPH",
"middle_name": "CHARLES",
"name_prefix": "Dr.",
"name_suffix": "Sr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "AZ",
"license": "3165",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Parker, AZ
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.