Provider Demographics
NPI:1962511790
Name:PROCTOR, RUSSELL J (MD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:J
Last Name:PROCTOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 689022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-9022
Mailing Address - Country:US
Mailing Address - Phone:615-465-7390
Mailing Address - Fax:615-628-6877
Practice Address - Street 1:25908 CANAL RD STE D
Practice Address - Street 2:
Practice Address - City:ORANGE BEACH
Practice Address - State:AL
Practice Address - Zip Code:36561-5015
Practice Address - Country:US
Practice Address - Phone:251-952-6653
Practice Address - Fax:844-204-4753
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18875207RS0012X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL253180Medicaid
AL253177Medicaid
AL051557066Medicaid
AL253177Medicaid
AL529931840OtherMEDICAID GROUP
AL051558309Medicare PIN
AL051558309Medicare PIN