Provider Demographics
NPI:1255392890
Name:KING, JOSEPH WALTER III (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WALTER
Last Name:KING
Suffix:III
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:PO BOX 232
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33526-0232
Mailing Address - Country:US
Mailing Address - Phone:352-518-2000
Mailing Address - Fax:352-567-1974
Practice Address - Street 1:11645 BISCAYNE BLVD STE 309
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-3139
Practice Address - Country:US
Practice Address - Phone:055-388-8353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA30492207V00000X
OK23325207V00000X
FLME106952207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000358883FMedicaid
FL009934300Medicaid
OK200010040AMedicaid
FL009934300Medicaid
GA000358883FMedicaid