King, Broderick Daryl
King, Broderick Daryl is an individual health care provider with primary practice located at 101 Aubreys Loop , South Boston VA 24592-5056. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. King, Broderick Daryl can be contacted via phone (434) 517-3879.Contact Information
Primary practice address
101 Aubreys Loop
South Boston VA 24592-5056
Phone: (434) 517-3879
Fax: (434) 517-3989
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 0101234095 | Virginia |
Profile Details
| NPI number | 1770551889 |
|---|---|
| LBN Legal business name | King, Broderick Daryl |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 14th, 2006 |
| Last updated | Dec 27th, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1770551889 | NPPES |
| Virginia | Other | 288916 | BCBS |
| Virginia | MEDICAID | 005882451 | BCBS |
| Virginia | Other | 62491 | BCBS |
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