Provider Demographics
NPI:1174855811
Name:R TAYLOR KING, M.D.
Entity Type:Organization
Organization Name:R TAYLOR KING, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICE
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-296-1044
Mailing Address - Street 1:4237 SALISBURY RD STE 311
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8089
Mailing Address - Country:US
Mailing Address - Phone:904-296-1044
Mailing Address - Fax:904-296-3081
Practice Address - Street 1:4237 SALISBURY RD STE 311
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8089
Practice Address - Country:US
Practice Address - Phone:904-296-1044
Practice Address - Fax:904-296-3081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16788Medicare PIN