Provider Demographics
NPI:1639129414
Name:JESSICA PROCTER, M.D.,P.A.
Entity Type:Organization
Organization Name:JESSICA PROCTER, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PROCTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-566-5563
Mailing Address - Street 1:7777 FOREST LN
Mailing Address - Street 2:SUITE B242
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2505
Mailing Address - Country:US
Mailing Address - Phone:972-566-5563
Mailing Address - Fax:972-566-5587
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:SUITE B242
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2505
Practice Address - Country:US
Practice Address - Phone:972-566-5563
Practice Address - Fax:972-566-5587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6522207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00570YMedicare PIN