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General NPI Number Information
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NPI Number | 1477962165
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Entity Type | Organization
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Legal Business Name | KINGS PEAK EMERGENCY PHYSICIANS LLC
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Dates
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Enumeration Date | 08/06/2014
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Last Update Date | 01/24/2019
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Provider Practice Location Address
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Address Line | 12512 US 301
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City | RIVERVIEW
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State | FL
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Zip | 33578
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Country | US
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Telephone | 954-838-2371
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Fax |
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Provider Business Mailing Address
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Address Line | 3114 CROASDAILE DR STE 200
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City | DURHAM
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State | NC
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Zip | 27705-2508
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | TENNA K BEHM
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Credential |
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Telephone | 954-838-2371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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