Provider Demographics
NPI:1720409121
Name:PROTEXTOR, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:PROTEXTOR
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 1:334 LINDA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-2008
Mailing Address - Country:US
Mailing Address - Phone:575-993-1017
Mailing Address - Fax:
Practice Address - Street 1:334 LINDA VISTA RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2008
Practice Address - Country:US
Practice Address - Phone:575-993-1017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator