Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | LP04262 | RI |
NPI | 1295226041 |
---|---|
Provider Name | Victor Andrew King |
First Address | Providence, RI 02903-4923 |
Second Address | Providence, RI 02903-4923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2018 |
Last Update Date | 27/05/2018 |