Provider Demographics
NPI:1851399349
Name:KING, WILLIAM BRYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRYAN
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 N LAWNWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4835
Mailing Address - Country:US
Mailing Address - Phone:772-465-6484
Mailing Address - Fax:772-465-0163
Practice Address - Street 1:1401 N LAWNWOOD CIR
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4835
Practice Address - Country:US
Practice Address - Phone:772-465-6484
Practice Address - Fax:772-465-0163
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0039583207V00000X
FL592463341174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066678500Medicaid
FLK7192Medicare ID - Type UnspecifiedGROUP NUMBER
FL066678500Medicaid
FLD62456Medicare UPIN