Healthcare Provider Details

I. General information

NPI: 1164583266
Provider Name (Legal Business Name): WILLIAM B KING MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N LAWNWOOD CIRCLE
FT PIERCE FL
34950
US

IV. Provider business mailing address

1401 N LAWNWOOD CIRCLE
FT PIERCE FL
34950
US

V. Phone/Fax

Practice location:
  • Phone: 772-465-6484
  • Fax: 772-465-0163
Mailing address:
  • Phone: 772-465-6484
  • Fax: 772-465-0163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME39583
License Number StateFL

VIII. Authorized Official

Name: WILLIAM BRYAN KING
Title or Position: PRACTITIONER
Credential: MD
Phone: 772-465-6484