Provider Demographics
NPI:1780643486
Name:KING, MONROE JAMES (DO)
Entity type:Individual
Prefix:
First Name:MONROE
Middle Name:JAMES
Last Name:KING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11200 SEMINOLE BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33778-3239
Mailing Address - Country:US
Mailing Address - Phone:727-397-8557
Mailing Address - Fax:727-397-4459
Practice Address - Street 1:11200 SEMINOLE BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-3239
Practice Address - Country:US
Practice Address - Phone:727-397-8557
Practice Address - Fax:727-397-4459
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0003842207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042758601Medicaid
FL379152100Medicaid
FL57216WMedicare PIN
FL042758601Medicaid