Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | ME124146 | FL |
NPI | 1003101288 |
---|---|
Provider Name | Dr. Forrest King |
First Address | Jacksonville, FL 32246-5556 |
Second Address | Orange Park, FL 32073-5156 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2011 |
Last Update Date | 24/09/2020 |