Healthcare Provider Details

I. General information

NPI: 1861484396
Provider Name (Legal Business Name): AUGUST DANIEL KING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 05/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 S COOLIDGE ST
MOSES LAKE WA
98837-1893
US

IV. Provider business mailing address

605 S. COOLIDGE STREET
MOSES LAKE WA
98837-1863
US

V. Phone/Fax

Practice location:
  • Phone: 509-765-0674
  • Fax: 509-765-6591
Mailing address:
  • Phone: 509-765-0674
  • Fax: 509-765-6591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD60142503
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: