Organization
LAKESHORE SURGICAL PRACTICE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD J KING MD (PHYSICIAN)
(585) 637-2930
Entity
Organization
Contact information
Practice address
30 ERIE CANAL DR, SUITE E, ROCHESTER, NY 14626-4604
(585) 637-2930
(585) 637-2930
Mailing address
1 PARK AVE, BROCKPORT, NY 14420-1913
(585) 637-2930
(585) 507-4707
Taxonomy
Speciality
Code
Description
License number
State
2086S0102X
Surgical Critical Care Physician
Primary
239232
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02752716
—
NY
Enumeration date
09/09/2013
Last updated
09/09/2013
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