Provider Demographics
NPI:1679511471
Name:PROCTOR, JOHN H (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:PROCTOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 634706
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:865-292-3000
Mailing Address - Fax:
Practice Address - Street 1:391 WALLACE RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4851
Practice Address - Country:US
Practice Address - Phone:615-781-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20700207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3051994OtherBLUECROSS
TN3052176Medicaid
TN3159791OtherBLUECROSS
TNP00220920OtherRAILROAD MEDICARE
KY000000076048OtherBLUECROSS
MS00019934Medicaid
TN3077695OtherBLUECROSS
TNP00332581OtherRAILROAD MEDICARE
TN3052175Medicaid
KY64798630Medicaid
TN3052177Medicaid
AR5M197OtherBLUECROSS
TNP00248226OtherRAILROAD MEDICARE
AR5M197OtherBLUECROSS
TN3159791OtherBLUECROSS
TN3052177Medicaid
TN3052176Medicare PIN