Provider Demographics
NPI:1295759025
Name:KING, SCOTTIE LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTTIE
Middle Name:LYNN
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 1:5750 BUNKER HILL RD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75048
Mailing Address - Country:US
Mailing Address - Phone:975-675-5300
Mailing Address - Fax:972-675-5301
Practice Address - Street 1:5750 BUNKER HILL RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75048
Practice Address - Country:US
Practice Address - Phone:975-675-5300
Practice Address - Fax:972-675-5301
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8927207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH10112Medicare UPIN