Healthcare Provider Details

I. General information

NPI: 1760493548
Provider Name (Legal Business Name): RODERICK ALLAN KING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 SW ALLAPATTAH RD
INDIANTOWN FL
34956-4307
US

IV. Provider business mailing address

96 SW ALLAPATTAH RD
INDIANTOWN FL
34956-4307
US

V. Phone/Fax

Practice location:
  • Phone: 772-597-9400
  • Fax:
Mailing address:
  • Phone: 772-597-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME147478
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: