Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | G5250 | TX |
Y | 207PP0204X | Pediatric Emergency Physician | C10010378 | DE |
N | 207PP0204X | Pediatric Emergency Physician | G5250 | TX |
N | 2080P0204X | Pediatric Emergency Doctor | G5250 | TX |
NPI | 1063455483 |
---|---|
Provider Name | Brent R. King |
First Address | Rockland, DE 19723-0191 |
Second Address | Wilmington, DE 19803-3607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 25/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
137016503 | (05) | TX |
137016510 | CSHCN (01) | TX |
82988K | BCBS (01) | TX |
C17888 | (02) | TX |