Healthcare Provider Details

I. General information

NPI: 1649249491
Provider Name (Legal Business Name): TERRY DEAN KING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PAVILION RD
WEST MONROE LA
71292-9470
US

IV. Provider business mailing address

300 PAVILION RD
WEST MONROE LA
71292-9470
US

V. Phone/Fax

Practice location:
  • Phone: 318-323-1100
  • Fax: 318-323-1161
Mailing address:
  • Phone: 318-323-1100
  • Fax: 318-323-1161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberMD.02443R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: