Provider Demographics
NPI:1033178173
Name:KING, DENNIS C (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:C
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 36TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4862
Mailing Address - Country:US
Mailing Address - Phone:772-567-4311
Mailing Address - Fax:772-563-4723
Practice Address - Street 1:4165 9TH ST SW
Practice Address - Street 2:SUITE 106
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32968-4878
Practice Address - Country:US
Practice Address - Phone:772-569-7706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110955207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01009110OtherMEDICARE RAILROAD
FL14H5DOtherBCBS OF FL
FL00407990Medicaid
FL14H5DOtherBCBS OF FL