Healthcare Provider Details

I. General information

NPI: 1104113430
Provider Name (Legal Business Name): J MICHAEL KING MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 SUMMIT BLVD UNIT 204
BROOMFIELD CO
80021-8253
US

IV. Provider business mailing address

1276 HAWK RIDGE RD
LAFAYETTE CO
80026-2985
US

V. Phone/Fax

Practice location:
  • Phone: 720-401-2139
  • Fax: 303-469-2898
Mailing address:
  • Phone: 720-401-2139
  • Fax: 303-469-2898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JUSTIN MICHAEL KING
Title or Position: OWNER
Credential: M.D.
Phone: 720-401-2139