Provider Demographics
NPI:1467633123
Name:PROCTOR, FRANK GRAYSON
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:GRAYSON
Last Name:PROCTOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 OLD WRIGHT SHOP RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:24572-3673
Mailing Address - Country:US
Mailing Address - Phone:434-845-5362
Mailing Address - Fax:434-845-4475
Practice Address - Street 1:349 OLD WRIGHT SHOP RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:24572-3673
Practice Address - Country:US
Practice Address - Phone:434-845-5362
Practice Address - Fax:434-845-4475
Is Sole Proprietor?:No
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver