Healthcare Provider Details

I. General information

NPI: 1255338083
Provider Name (Legal Business Name): MARY J KING DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6832 14TH ST W UNIT 3
BRADENTON FL
34207-5866
US

IV. Provider business mailing address

102 WOODMONT BLVD STE 600
NASHVILLE TN
37205-5250
US

V. Phone/Fax

Practice location:
  • Phone: 941-297-2022
  • Fax: 941-297-2209
Mailing address:
  • Phone: 888-987-1151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS0007369
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: