Provider Demographics
NPI:1629082284
Name:PROCTOR, LINDA R (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:R
Last Name:PROCTOR
Suffix:
Gender:F
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:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-996-5170
Mailing Address - Fax:314-996-4261
Practice Address - Street 1:3015 N BALLAS RD
Practice Address - Street 2:DEPT RADIOLOGY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2329
Practice Address - Country:US
Practice Address - Phone:314-996-5170
Practice Address - Fax:314-996-4261
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1058092085R0202X
IL0361096642085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209728815Medicaid
1601784OtherPH PLAN
403502OtherH LINK
041012444OtherMO CARE
209728815OtherMO CAID
300130877OtherRR CARE
431725842MIDOtherMERCY
P00001472OtherRR CARE
017013128OtherMO CARE
041012444OtherCARE
1390OtherMO BLUE
2781OtherGHP
P00001472OtherRR CARE
403502OtherH LINK