Doctor Name: | DR. KEITH E PROCTOR |
NPI Number: | 1407021694 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | TRAINING LICENSE |
Business Practice Address: | 202 Maplewood Ave Ronceverte, WV - 249701334 |
Business Phone Number: | 3046476529 |
Business Fax Number: | 3047932279 |
Mailing Address: | 202 Maplewood Ave, RONCEVERTE |
State: | WV |
Postal Code: | 249701334 |
Phone Number: | 3046476529 |
Fax Number: | 3047932279 |
NPI Enumeration Date: | 04/28/2008 |
NPI Last Update Date: | 04/28/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | TRAINING LICENSE |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |