Provider Demographics
NPI:1275519886
Name:KING, LAWRENCE P (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:P
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1005 MAR WALT DR
Mailing Address - Street 2:PEDIATRIC DEPARTMENT
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6707
Mailing Address - Country:US
Mailing Address - Phone:850-863-8203
Mailing Address - Fax:850-862-0977
Practice Address - Street 1:1005 MAR WALT DR
Practice Address - Street 2:PEDIATRIC DEPARTMENT
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6707
Practice Address - Country:US
Practice Address - Phone:850-863-8203
Practice Address - Fax:850-862-0977
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME26981208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055399900Medicaid
FL12963XMedicare ID - Type Unspecified
D23946Medicare UPIN