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Individual

MR. LARRY KING

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
600 MOYE BLVD, CARDIOTHORACIC OUTPATIENT CLINIC - DEPT. OF SURGERY, GREENVILLE, NC 27858
(252) 744-4822
(252) 744-5192
Mailing address
PO BOX 751069, CHARLOTTE, NC 28275-1069
(252) 744-3253
(252) 744-3194

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
0001-00051
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
970016852
RAILROAD MEDICARE
NC
Enumeration date
01/05/2006
Last updated
04/21/2010
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