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General NPI Number Information
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NPI Number | 1750526398
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Entity Type | Organization
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Legal Business Name | EMERALD COAST EMERGENCY PHYSICIANS LLP
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Dates
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Enumeration Date | 12/11/2008
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Last Update Date | 09/21/2009
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Provider Practice Location Address
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Address Line | 1000 MAR-WALT DRIVE
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6795
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Country | US
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Telephone | 850-862-1111
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Fax | 850-862-9149
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Provider Business Mailing Address
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Address Line | PO BOX 602162
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City | CHARLOTTE
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State | NC
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Zip | 28260-2162
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Country | US
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Telephone | 866-916-5259
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Fax | 231-922-4030
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Authorized Official
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Title or Position | LLP MANAGING PARTNER
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Name | DR. DERIK K KING
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Credential | MD
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Telephone | 866-916-5259
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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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