MEDICARE: DR. KAILEY D PROCTOR DO

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	390200000X	Student in an Organized Health Care Education/Training Program
2	208000000X	Pediatrics Physician	DR0074765	CO

General Provider Information

NPI Number	:	1245972868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAILEY D PROCTOR DO

Provider Business Mailing Address
First Line	:	86 W UNDERWOOD ST STE 202
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32806-1110
Country	:	US
Telephone Number	:	321-841-8642
Fax Number	:	407-872-0544

Provider Business Practice Location Address
First Line	:	5680 N TOWER RD STE 120
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80249-8024
Country	:	US
Telephone Number	:	720-734-8816
Fax Number	:	720-405-4454

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

Provider Enumeration Date	:	04/13/2022
Last Update Date	:	03/24/2025

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