Healthcare Provider Details

I. General information

NPI: 1629062351
Provider Name (Legal Business Name): ROBERT KING PERSONS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALTON COUNTY HEALTH DEPARTMENT 3162 HIGHWAY 83
DEFUNIAK SPRINGS FL
32433
US

IV. Provider business mailing address

362 STATE HIGHWAY 83
DEFUNIAK SPRINGS FL
32433-3800
US

V. Phone/Fax

Practice location:
  • Phone: 850-892-8015
  • Fax:
Mailing address:
  • Phone: 850-892-8015
  • Fax: 850-892-8457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS4692
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS0004692
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: