=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235205188
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WARREN L KING MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/24/2006
-----------------------------------------------------
Last Update Date | 01/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21301 POWERLINE RD # 304
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-482-5035
-----------------------------------------------------
Fax | 561-487-4761
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21301 POWERLINE RD # 304 WARREN L KING MD PA
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-482-5035
-----------------------------------------------------
Fax | 561-487-4761
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | WARREN L KING
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 561-482-5035
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | ME0063396
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------