Provider Demographics
NPI:1891777520
Name:KING, G. TERRAL (MD)
Entity Type:Individual
Prefix:DR
First Name:G.
Middle Name:TERRAL
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 1:4996 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2344
Mailing Address - Country:US
Mailing Address - Phone:850-475-9040
Mailing Address - Fax:850-475-9049
Practice Address - Street 1:4996 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2344
Practice Address - Country:US
Practice Address - Phone:850-475-9040
Practice Address - Fax:850-475-9049
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL120032085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51030105OtherBCBS
000030105Medicare PIN
AL51030105OtherBCBS