Provider Demographics
NPI:1811082019
Name:KING, SHERRY ANNE (MD)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:ANNE
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14810 OLD ST AUGUSTINE RD.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258
Mailing Address - Country:US
Mailing Address - Phone:904-260-2995
Mailing Address - Fax:904-260-2996
Practice Address - Street 1:14810 OLD ST AUGUSTINE RD.
Practice Address - Street 2:SUITE 101
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258
Practice Address - Country:US
Practice Address - Phone:904-260-2995
Practice Address - Fax:904-260-2996
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63140207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375294100Medicaid
F78234Medicare UPIN
FL25137UMedicare PIN