Provider Demographics
NPI:1710197967
Name:DEEN G KING MD PA
Entity Type:Organization
Organization Name:DEEN G KING MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEEN
Authorized Official - Middle Name:GRAY
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-877-5300
Mailing Address - Street 1:508 S HABANA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4181
Mailing Address - Country:US
Mailing Address - Phone:813-877-5300
Mailing Address - Fax:813-877-6535
Practice Address - Street 1:508 S HABANA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4181
Practice Address - Country:US
Practice Address - Phone:813-877-5300
Practice Address - Fax:813-877-6535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046881900Medicaid
FL046881900Medicaid
FLD54141Medicare UPIN