Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 9900892 | NC |
NPI | 1124359781 |
---|---|
Provider Name | Doris King |
First Address | Wilmington, NC 28403-6816 |
Second Address | Wilmington, NC 28403-6816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2010 |
Last Update Date | 21/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
#FK1665251 | DEA (01) | NC |