MEDICARE: MRS. SUSAN MARENDA 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	207Y00000X	Otolaryngology Physician	H8230	TX
2	207YX0901X	Otology & Neurotology Physician	H8230	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396783528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN MARENDA KING M.D.

Provider Business Mailing Address
First Line	:	21 SPURS LN
Second Line	:	SUITE 100
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1669
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 SPURS LN
Second Line	:	SUITE 100
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1634
Country	:	US
Telephone Number	:	210-614-6070
Fax Number	:

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	12/13/2019

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