Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | ME67161 | FL |
NPI | 1265412589 |
---|---|
Provider Name | Laurel Anne King |
First Address | Hollywood, FL 33081-0967 |
Second Address | Miami, FL 33125-1610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 18/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
251359500 | (05) | FL |
27641 | BCBS (01) | FL |
D45862 | (02) |