Provider Demographics
NPI:1245486869
Name:FERNAND, KING (LMT)
Entity type:Individual
Prefix:
First Name:KING
Middle Name:
Last Name:FERNAND
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 496
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33802-0496
Mailing Address - Country:US
Mailing Address - Phone:863-286-1962
Mailing Address - Fax:
Practice Address - Street 1:2240 US HIGHWAY 92 E
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-2448
Practice Address - Country:US
Practice Address - Phone:863-286-1962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA47453174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist