Basic Information
| Provider Information | |||||||||
| NPI: | 1407910219 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | BOOKER | ||||||||
| MiddleName: | TERRY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | BURNETT WOMACK BLDG | ||||||||
| Address2: | CAMPUS BOX 7206 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199668159 | ||||||||
| FaxNumber: | 9198436568 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 NW 10TH AVE | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331361015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055851293 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2006 | ||||||||
| LastUpdateDate: | 04/08/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 2018-00970 | NC | Y | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | 215797 | NY | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
No ID Information.