MEDICARE: JOHN ROBERT KING JR. MD

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	207P00000X	Emergency Medicine Physician	11760	WV

General Provider Information

NPI Number	:	1407857667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN ROBERT KING JR. MD

Provider Business Mailing Address
First Line	:	67497 POGUE RD
Second Line	:
City	:	SAINT CLAIRSVILLE
State	:	OH
Zip	:	43950-8441
Country	:	US
Telephone Number	:	740-699-0407
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 E BENJAMIN DR
Second Line	:
City	:	NEW MARTINSVILLE
State	:	WV
Zip	:	26155-2705
Country	:	US
Telephone Number	:	304-455-8000
Fax Number	:

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	12/14/2022

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