Provider Demographics
NPI:1477162337
Name:PROCTOR, JACORY AUNGI
Entity Type:Individual
Prefix:
First Name:JACORY
Middle Name:AUNGI
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 1:3545 MAINER ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-5535
Mailing Address - Country:US
Mailing Address - Phone:713-493-1364
Mailing Address - Fax:
Practice Address - Street 1:3545 MAINER ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-5535
Practice Address - Country:US
Practice Address - Phone:713-493-1364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)