Healthcare Provider Details

I. General information

NPI: 1932267812
Provider Name (Legal Business Name): MAJ JOHN D. KING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USAMEDDAC WUERZBURG, UNIT 26610 US ARMHY HEALTH CLINIC, WUERZBURG
APO AE
09244
US

IV. Provider business mailing address

USAMEDDAC WUERZBURG UNIT 26610 ATTN CREDENTIALS OFFICE
APO AE
09244
US

V. Phone/Fax

Practice location:
  • Phone: 011499318043616
  • Fax: 011499318043241
Mailing address:
  • Phone: 011499318043616
  • Fax: 011499318043241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number431015
License Number StateCA

VIII. Authorized Official

Name: MR. PIERRE L SWAFFORD
Title or Position: CREDENTIALS PROGRAM MANAGER
Credential: DO
Phone: 011499318042457