Provider Demographics
NPI:1184811077
Name:PROCTOR, BENJAMIN L (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:L
Last Name:PROCTOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1109 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2749
Mailing Address - Country:US
Mailing Address - Phone:270-765-6066
Mailing Address - Fax:270-737-2354
Practice Address - Street 1:1109 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2749
Practice Address - Country:US
Practice Address - Phone:270-765-6066
Practice Address - Fax:270-737-2354
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
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Provider Licenses
StateLicense IDTaxonomies
KYR0908207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYR0908OtherSTATE LICENSE