Healthcare Provider Details

I. General information

NPI: 1407274756
Provider Name (Legal Business Name): BRIAN JAMES KING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 07/11/2020
Certification Date: 07/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 STONEGATE DR STE 130
VESTAVIA HLS AL
35242-2541
US

IV. Provider business mailing address

1940 STONEGATE DR STE 130
VESTAVIA HLS AL
35242-2541
US

V. Phone/Fax

Practice location:
  • Phone: 205-977-9876
  • Fax:
Mailing address:
  • Phone: 205-977-9876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number36855
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: