Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | J7836 | TX |
N | 2086S0120X | Pediatric Surgery | MD00041914 | WA |
N | 2086S0120X | Pediatric Surgery | PT13389 | ND |
NPI | 1023192747 |
---|---|
Provider Name | Monja L Proctor |
First Address | Lubbock, TX 79410-1105 |
Second Address | Lubbock, TX 79410-1122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 03/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1E9888 | MEDICARE (01) | TX |
8369837 | (05) | WA |