Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | 36855 | AL |
NPI | 1407274756 |
---|---|
Provider Name | Brian James King |
First Address | Vestavia Hls, AL 35242-2541 |
Second Address | Vestavia Hls, AL 35242-2541 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2014 |
Last Update Date | 11/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36855 | AL MEDICAL LICENSE (01) | AL |
59729 | MN MEDICAL LISCENCE (01) | MN |