Healthcare Provider Details

I. General information

NPI: 1124025846
Provider Name (Legal Business Name): RICHARD CHRISTIAN KING D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 N ROAD ST SUITE B
ELIZABETH CITY NC
27909-3334
US

IV. Provider business mailing address

1121 N ROAD ST SUITE B
ELIZABETH CITY NC
27909-3334
US

V. Phone/Fax

Practice location:
  • Phone: 252-338-2111
  • Fax: 252-338-2113
Mailing address:
  • Phone: 252-338-2111
  • Fax: 252-338-2113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number167
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: