MEDICARE: SUSAN C KING 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	207Q00000X	Family Medicine Physician	L1633	TX

General Provider Information

NPI Number	:	1669459327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN C KING MD

Provider Business Mailing Address
First Line	:	1907 CYPRESS CREEK RD
Second Line	:	SUITE 104
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-4150
Country	:	US
Telephone Number	:	512-346-7966
Fax Number	:	512-346-7196

Provider Business Practice Location Address
First Line	:	1907 CYPRESS CREEK RD
Second Line	:	SUITE 104
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-4150
Country	:	US
Telephone Number	:	512-346-7966
Fax Number	:	512-346-7196

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

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	07/22/2011

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