Healthcare Provider Details

I. General information

NPI: 1457437055
Provider Name (Legal Business Name): MICHAEL KING JASON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8839 BRYAN DAIRY RD SUITE 300
LARGO FL
33777-1203
US

IV. Provider business mailing address

455 PINELLAS ST SUITE 400
CLEARWATER FL
33756-3354
US

V. Phone/Fax

Practice location:
  • Phone: 727-394-1911
  • Fax: 727-394-1986
Mailing address:
  • Phone: 727-445-1992
  • Fax: 727-445-1993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number136861
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME122604
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: