Healthcare Provider Details

I. General information

NPI: 1255350021
Provider Name (Legal Business Name): JOHN KING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 04/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 BAPTIST HEALTH DR STE 200
LITTLE ROCK AR
72205-6243
US

IV. Provider business mailing address

9800 BAPTIST HEALTH DR STE 200
LITTLE ROCK AR
72205-6243
US

V. Phone/Fax

Practice location:
  • Phone: 501-219-0900
  • Fax: 501-312-4750
Mailing address:
  • Phone: 501-219-0900
  • Fax: 501-312-4750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberE8699
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: