Healthcare Provider Details

I. General information

NPI: 1528642063
Provider Name (Legal Business Name): JACKSON MARK KING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W 5TH AVE STE 301
SPOKANE WA
99204-2714
US

IV. Provider business mailing address

PO BOX 5299 MS: 820-5-PCO
TACOMA WA
98415-0299
US

V. Phone/Fax

Practice location:
  • Phone: 509-342-3350
  • Fax: 509-342-3377
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD.MD.70089025
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: