Provider Demographics
NPI:1972861326
Name:PROCTOR, RYAN MARK (DO)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:MARK
Last Name:PROCTOR
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Gender:M
Credentials:DO
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Mailing Address - Street 1:3015 HWAY 95
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-4334
Mailing Address - Country:US
Mailing Address - Phone:928-758-8885
Mailing Address - Fax:928-758-2424
Practice Address - Street 1:3015 HWAY 95
Practice Address - Street 2:SUITE 110
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-4334
Practice Address - Country:US
Practice Address - Phone:928-758-8885
Practice Address - Fax:928-758-2424
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2014-03-12
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Provider Licenses
StateLicense IDTaxonomies
AZ006043207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology