MEDICARE: DR. JOHN A. KING M.D.

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	2086S0129X	Vascular Surgery Physician	ME25761	FL

General Provider Information

NPI Number	:	1336159771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN A. KING M.D.

Provider Business Mailing Address
First Line	:	PO BOX 530005
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33153-0005
Country	:	US
Telephone Number	:	305-754-1087
Fax Number	:	305-758-3632

Provider Business Practice Location Address
First Line	:	1300 NE 103RD ST
Second Line	:
City	:	MIAMI SHORES
State	:	FL
Zip	:	33138-2624
Country	:	US
Telephone Number	:	305-754-1087
Fax Number	:	305-758-3632

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	07/08/2007

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