Provider Demographics
NPI:1649872680
Name:PROCTOR PERSONAL MD, PLLC
Entity type:Organization
Organization Name:PROCTOR PERSONAL MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:V
Authorized Official - Last Name:HAMILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-759-3586
Mailing Address - Street 1:2517 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-5841
Mailing Address - Country:US
Mailing Address - Phone:253-759-3586
Mailing Address - Fax:253-759-5746
Practice Address - Street 1:2517 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-5841
Practice Address - Country:US
Practice Address - Phone:253-759-3586
Practice Address - Fax:253-759-5746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1578655148OtherTYPE I NPI