Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 10762 | AL |
NPI | 1902896509 |
---|---|
Provider Name | Dr. Lucie Monette King |
First Address | Tuscaloosa, AL 35403-2689 |
Second Address | Tuscaloosa, AL 35401-2086 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2005 |
Last Update Date | 14/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C75423 | (02) | AL |