Healthcare Provider Details

I. General information

NPI: 1629497888
Provider Name (Legal Business Name): MAURICE L. KING III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 ESSEN LN
BATON ROUGE LA
70809-3738
US

IV. Provider business mailing address

5215 ESSEN LN STE 200
BATON ROUGE LA
70809-3543
US

V. Phone/Fax

Practice location:
  • Phone: 225-767-0847
  • Fax: 225-767-1335
Mailing address:
  • Phone: 225-215-1281
  • Fax: 225-215-1380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number324018
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: