Healthcare Provider Details

I. General information

NPI: 1588630545
Provider Name (Legal Business Name): NEIL M KING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BREWSTER BLVD PSC 351
CAMP LEJEUNE NC
28547-2538
US

IV. Provider business mailing address

130 LA VALETTE AVE
NORFOLK VA
23504-1039
US

V. Phone/Fax

Practice location:
  • Phone: 910-450-4520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number9701796
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: