Provider Demographics
NPI:1881653178
Name:PROCTOR, WILLIAM C
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:PROCTOR
Suffix:
Gender:M
Credentials:
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9040 FITZSIMMONS DR
Mailing Address - Street 2:MADIGAN ARMY MEDICAL CENTER
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98433-1100
Mailing Address - Country:US
Mailing Address - Phone:253-968-1351
Mailing Address - Fax:253-968-3731
Practice Address - Street 1:9040 FITZSIMMONS DR
Practice Address - Street 2:MADIGAN ARMY MEDICAL CENTER
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98433-1100
Practice Address - Country:US
Practice Address - Phone:253-968-1351
Practice Address - Fax:253-968-3731
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00000621103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB08851Medicare PIN
WAS83737Medicare UPIN