MEDICARE: DR. DONALD PROCTOR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ND0101X	MOHS-Micrographic Surgery Physician	ME0064734	FL
2	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	ME0064734	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	28426	OTHER	FL	BLUE CROSS

General Provider Information

NPI Number	:	1043219405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD PROCTOR M.D.

Provider Business Mailing Address
First Line	:	2206 E OCEAN OAKS LN
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32963-3104
Country	:	US
Telephone Number	:	772-567-1164
Fax Number	:	772-770-0799

Provider Business Practice Location Address
First Line	:	1325 36TH ST
Second Line	:	SUITE A
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6599
Country	:	US
Telephone Number	:	772-567-1164
Fax Number	:	772-770-0799

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	09/11/2025

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Directions to “ DR. DONALD PROCTOR M.D.” Practice Location

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