=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376846121
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STUART W. KING, M.D., LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2010
-----------------------------------------------------
Last Update Date | 12/17/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 839 E 1200 S
-----------------------------------------------------
City | OREM
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84097-6603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-224-0891
-----------------------------------------------------
Fax | 801-224-7100
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 970188
-----------------------------------------------------
City | OREM
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84097-0188
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-224-0891
-----------------------------------------------------
Fax | 801-224-7100
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | STUART WESLEY KING
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 801-224-0891
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------