Provider Demographics
NPI:1972704872
Name:AMY G PROFFER M. D.
Entity Type:Organization
Organization Name:AMY G PROFFER M. D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:G
Authorized Official - Last Name:PROFFER
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:806-351-1560
Mailing Address - Street 1:PO BOX 50360
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79159-0360
Mailing Address - Country:US
Mailing Address - Phone:806-351-1560
Mailing Address - Fax:806-351-0343
Practice Address - Street 1:7100 W 9TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1704
Practice Address - Country:US
Practice Address - Phone:806-351-1560
Practice Address - Fax:806-351-0343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0872207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric AnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F5040Medicare PIN