Provider Demographics
NPI:1417968892
Name:DOCTOR'S CHOICE MEDICAL, INC
Entity Type:Organization
Organization Name:DOCTOR'S CHOICE MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:K
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:LO, PTA
Authorized Official - Phone:954-978-8600
Mailing Address - Street 1:9315 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4101
Mailing Address - Country:US
Mailing Address - Phone:954-978-8600
Mailing Address - Fax:954-978-8688
Practice Address - Street 1:9315 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4101
Practice Address - Country:US
Practice Address - Phone:954-978-8600
Practice Address - Fax:954-978-8688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLORT121335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025542400Medicaid
FL025542400Medicaid