| Doctor Name: | MR. ERRON CODY PROCTOR |
| NPI Number: | 1427067859 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PAC |
| License Number: | 1410 |
| Business Practice Address: | 527 West 3rd St Konawa, OK - 74849 |
| Business Phone Number: | 5809253286 |
| Business Fax Number: | 5809252362 |
| Mailing Address: | Po Box 358, 527 West 3rd St KONAWA |
| State: | OK |
| Postal Code: | 74849 |
| Phone Number: | 5809253286 |
| Fax Number: | 5809259149 |
| NPI Enumeration Date: | 08/05/2006 |
| NPI Last Update Date: | 02/18/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 1410 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |