Healthcare Provider Details

I. General information

NPI: 1285674119
Provider Name (Legal Business Name): JOHN C KING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4608 HIGHWAY 1 SUITE 230
RACELAND LA
70394-2623
US

IV. Provider business mailing address

1545 HIGHWAY 654
GHEENS LA
70355-2103
US

V. Phone/Fax

Practice location:
  • Phone: 985-446-5210
  • Fax: 985-446-8327
Mailing address:
  • Phone: 985-446-5210
  • Fax: 985-446-8327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD 08070R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number08070R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: