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General NPI Number Information
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NPI Number | 1780871491
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Entity Type | Organization
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Legal Business Name | PROCTOR DERMATOLOGY & SKIN SURGERY PA
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 02/21/2008
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Provider Practice Location Address
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Address Line | 1609 PASADENA AVE S SUITE 4 0
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City | SOUTH PASADENA
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State | FL
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Zip | 33707-4565
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Country | US
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Telephone | 727-345-8050
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Fax | 727-345-4344
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Provider Business Mailing Address
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Address Line | 1609 PASADENA AVE S SUITE 4 0
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City | SOUTH PASADENA
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State | FL
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Zip | 33707-4565
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Country | US
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Telephone | 727-345-8050
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Fax | 727-345-4344
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL SCOTT PROCTOR
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Credential | MD
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Telephone | 727-345-8050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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