| NPI | 1700923190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD C PROCTOR President 772-567-1165 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: FL ME0064734) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME0064734) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2020-08-22 |