Provider Demographics
NPI:1861468456
Name:KING, DEEN G (MD)
Entity Type:Individual
Prefix:DR
First Name:DEEN
Middle Name:G
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 1:403 VONDERBURG DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5982
Mailing Address - Country:US
Mailing Address - Phone:813-813-6811
Mailing Address - Fax:813-681-1122
Practice Address - Street 1:3115 W SWANN AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4617
Practice Address - Country:US
Practice Address - Phone:813-492-2020
Practice Address - Fax:813-492-2099
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38743207WX0009X
FLME0038743207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046881900Medicaid
FL4233973OtherAETNA
GA180034717Medicare UPIN
FLD54141Medicare UPIN
FL30824Medicare PIN
FL046881900Medicaid
FL30824FMedicare PIN