Provider Demographics
NPI:1780769885
Name:PROCTOR, STEPHEN D (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:D
Last Name:PROCTOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:421 STATESVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2317
Mailing Address - Country:US
Mailing Address - Phone:704-636-8895
Mailing Address - Fax:704-636-9182
Practice Address - Street 1:421 STATESVILLE BLVD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2317
Practice Address - Country:US
Practice Address - Phone:704-636-8895
Practice Address - Fax:704-636-9182
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2013-11-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC33290207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00119673OtherRAILROAD MEDICARE
NC69316OtherBCBS OF NC
NC4105OtherPARTNERS NATIONAL HEALTH
NC8969316Medicaid
NC8969316Medicaid
NC4105OtherPARTNERS NATIONAL HEALTH
NCE04291Medicare UPIN