MEDICARE: DR. EDWARD THOMAS KING M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083X0100X	Occupational Medicine Physician	13590	OK

General Provider Information

NPI Number	:	1184612152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD THOMAS KING M.D.

Provider Business Mailing Address
First Line	:	PO BOX 30243
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73003-0005
Country	:	US
Telephone Number	:	405-330-0830
Fax Number	:

Provider Business Practice Location Address
First Line	:	8941 ENTRANCE RD A, BLDG 3334
Second Line	:
City	:	TINKER AFB
State	:	OK
Zip	:	73145-3065
Country	:	US
Telephone Number	:	405-582-6836
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	04/23/2018

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