Provider Demographics
NPI:1235205188
Name:WARREN L KING MD PA
Entity Type:Organization
Organization Name:WARREN L KING MD PA
Other - Org Name:WARREN L KING MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-482-5035
Mailing Address - Street 1:21301 POWERLINE RD
Mailing Address - Street 2:# 304 WARREN L KING MD PA
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433
Mailing Address - Country:US
Mailing Address - Phone:561-482-5035
Mailing Address - Fax:561-487-4761
Practice Address - Street 1:21301 POWERLINE RD
Practice Address - Street 2:# 304
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433
Practice Address - Country:US
Practice Address - Phone:561-482-5035
Practice Address - Fax:561-487-4761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00633962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25180Medicare ID - Type Unspecified
C12272Medicare UPIN