Basic Information
| Provider Information | |||||||||
| NPI: | 1982091237 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | SCOTT | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3200 MACCORKLE AVE SE | ||||||||
| Address2: | CAMC MEMORIAL HOSPITAL SURGICARE | ||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253041227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043885590 | ||||||||
| FaxNumber: | 3043888238 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 OKATIE CTR BLVD STE 350 | ||||||||
| Address2: | |||||||||
| City: | OKATIE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299097511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437062255 | ||||||||
| FaxNumber: | 8437062257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2015 | ||||||||
| LastUpdateDate: | 07/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 83155 | SC | Y | Allopathic & Osteopathic Physicians | Urology |
No ID Information.