Provider Demographics
NPI:1093780330
Name:PROCTER, BRIAN C (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:C
Last Name:PROCTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7692 ELDORADO PKWY W
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-5652
Mailing Address - Country:US
Mailing Address - Phone:972-562-8388
Mailing Address - Fax:972-540-2219
Practice Address - Street 1:7692 ELDORADO PKWY W
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-5652
Practice Address - Country:US
Practice Address - Phone:972-562-8388
Practice Address - Fax:972-540-2219
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7202207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTX5957OtherPHCS
TX930093930OtherPALMETTO GBA RAILROAD
TX0063EROtherBCBS
TX930093930OtherPALMETTO GBA RAILROAD
TXH03310Medicare UPIN