Individual
CHARLES DANIEL PROCTER SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8767 PERIMETER PARK BLVD, JACKSONVILLE, FL 32216-5479
(904) 402-8346
(904) 402-8347
Mailing address
1824 KING ST STE 200, JACKSONVILLE, FL 32204-4736
(904) 384-3343
(904) 400-6671
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
035736
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000502873I
—
GA
05
—
000502873J
—
GA
05
—
000502873K
—
GA
05
—
000502873M
—
GA
05
—
000502873R
—
GA
05
—
000502873S
—
GA
05
—
000502873T
—
GA
01
—
01338970
AMERIGROUP
GA
01
—
1708262
WELLCARE
GA
01
—
544229
WELLCARE
GA
01
—
592947
BCBS
GA
Enumeration date
08/04/2006
Last updated
03/31/2025
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