Provider Demographics
NPI:1083646038
Name:KING, EDWARD W (DO)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:W
Last Name:KING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 829
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29528-0829
Mailing Address - Country:US
Mailing Address - Phone:843-347-8015
Mailing Address - Fax:843-347-8017
Practice Address - Street 1:2102 CROMLEY CIR STE A
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-3187
Practice Address - Country:US
Practice Address - Phone:843-999-0064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0297207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
930062143OtherMEDICARE RAILROAD
SC002972Medicaid
NC890605XMedicaid
20002420OtherFIRST CHOICE
930062143OtherMEDICARE RAILROAD
SCC332828822Medicare PIN