Individual
BRODERICK DARYL KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 AUBREYS LOOP, SOUTH BOSTON, VA 24592-5056
(434) 517-3879
(434) 517-3989
Mailing address
101 AUBREYS LOOP, SOUTH BOSTON, VA 24592-5056
(434) 517-3879
(434) 517-3989
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101234095
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005882451
—
VA
01
—
288916
BCBS
VA
01
—
62491
OPTIMA
VA
Enumeration date
03/14/2006
Last updated
12/27/2012
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