Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 3347 | AL |
NPI | 1154462547 |
---|---|
Provider Name | Dr. Thomas P. King |
First Address | Birmingham, AL 35235-2565 |
Second Address | Birmingham, AL 35235-2565 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
51093932 | BLUE CROSS BLUE SHIELD (01) | AL |
535068 | UNITED CONCORDIA (01) | AL |