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NPI Code Detail

MEDICARE: PHYSICIAN OF KING'S DAUGHTERS, P.A.

MEDICARE: PHYSICIAN OF KING'S DAUGHTERS, P.A.
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
1207K00000XAllergy & Immunology Physician
2207L00000XAnesthesiology Physician
3207R00000XInternal Medicine Physician
4207V00000XObstetrics & Gynecology Physician
5207W00000XOphthalmology Physician
6207X00000XOrthopaedic Surgery Physician
7207Y00000XOtolaryngology Physician
8207ZP0102XAnatomic Pathology & Clinical Pathology Physician
9208000000XPediatrics Physician
102085R0202XDiagnostic Radiology Physician
11208600000XSurgery Physician
12208800000XUrology Physician
13207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1699705616
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHYSICIAN OF KING'S DAUGHTERS, P.A.
Provider Business Mailing Address
First Line : 1905 SW H K DODGEN LOOP
Second Line :
City : TEMPLE
State : TX
Zip : 76502-1814
Country : US
Telephone Number : 254-298-2682
Fax Number : 254-778-7197
Provider Business Practice Location Address
First Line : 1300 E 6TH AVE
Second Line :
City : BELTON
State : TX
Zip : 76513-2810
Country : US
Telephone Number : 254-298-2682
Fax Number : 254-778-7197
Authorized Official
Title or Position : PROVIDER DIRECTOR
Name : LINDA C. PAYNE
Credential :
Telephone Number : 254-298-2682
Provider Enumeration Date : 07/04/2006
Last Update Date : 08/01/2008

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