Provider Demographics
NPI:1285843847
Name:P BRENT KING, D.O.
Entity Type:Organization
Organization Name:P BRENT KING, D.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:828-242-2582
Mailing Address - Street 1:101 CHADWICK SQUARE CT
Mailing Address - Street 2:SUITEC
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-3231
Mailing Address - Country:US
Mailing Address - Phone:828-696-2515
Mailing Address - Fax:828-696-8826
Practice Address - Street 1:101 CHADWICK SQUARE CT
Practice Address - Street 2:SUITEC
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-3231
Practice Address - Country:US
Practice Address - Phone:828-696-2515
Practice Address - Fax:828-696-8826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97-01437208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID NUMBER
23319397Medicare PIN