Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207ND0101X | MOHS-Micrographic Surgeon | ME0064734 | FL |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | ME0064734 | FL |
NPI | 1043219405 |
---|---|
Provider Name | Dr. Donald Proctor |
First Address | Vero Beach, FL 32963-3104 |
Second Address | Vero Beach, FL 32960-6599 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
28426 | BLUE CROSS (01) | FL |
G27618 | (02) | FL |