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1629635032
BRADLEY WAYNE PROCTOR
SAN DIEGO, CA
NPI
1629635032
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1710I1002X Military Health Care Provider, Independent Duty Corpsman
Enumeration Date
2019-05-21
Last Update Date
2019-05-21
Business Address
Mr. BRADLEY WAYNE PROCTOR IDC
34101 FARENHOLT AVE
SAN DIEGO, CA 92134-7000
Phone number: 619-532-7968
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Mailing Address
Mr. BRADLEY WAYNE PROCTOR IDC
530 GLENWOOD ST
BOSSIER CITY, LA 71111-2205
Phone number: 318-572-4557
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