MEDICARE: DR. SCOTTIE LYNN KING MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	K8927	TX

General Provider Information

NPI Number	:	1295759025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTTIE LYNN KING MD

Provider Business Mailing Address
First Line	:	5750 BUNKER HILL RD
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75048
Country	:	US
Telephone Number	:	975-675-5300
Fax Number	:	972-675-5301

Provider Business Practice Location Address
First Line	:	5750 BUNKER HILL RD
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75048
Country	:	US
Telephone Number	:	975-675-5300
Fax Number	:	972-675-5301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	10/02/2014

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