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Provider Information for 1295129401



DR. DEREK KING MD

Gender: MALE

Individual NPI: 1295129401

Calendar   Last Updated:  2019-09-18
  Certification Date: 

Details

Name Value
NPI 1295129401
Enumeration Date 2015-03-25
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 4302 HOLLYWOOD BLVD # 267
HOLLYWOOD, FL 33021-6635
United States

Phone: 786-774-2246 | Fax:
View Map External Link
Primary Practice Address 111 E 210TH ST
BRONX, NY 10467-2401
United States

Phone: 718-920-4316 | Fax:
View Map External Link
Secondary Practice Address 4302 HOLLYWOOD BLVD # 267
HOLLYWOOD, FL 33021-6635
United States

Phone: 786-774-2246 | Fax:
View Map External Link

Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other URL No
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 207L00000X - Anesthesiology NY 296341
No 208D00000X - General Practice FL ME135881