MEDICARE: DR. KEITH E PROCTOR D.O.

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	2083X0100X	Occupational Medicine Physician	0102202628	VA

General Provider Information

NPI Number	:	1407021694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH E PROCTOR D.O.

Provider Business Mailing Address
First Line	:	431 BATTLEFIELD MEMORIAL HWY BLDG S1
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-5107
Country	:	US
Telephone Number	:	859-779-6559
Fax Number	:

Provider Business Practice Location Address
First Line	:	431 BATTLEFIELD MEMORIAL HWY BLDG S1
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-5107
Country	:	US
Telephone Number	:	859-779-6559
Fax Number	:

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

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	01/22/2026

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