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General NPI Number Information
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NPI Number | 1457442691
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Entity Type | Individual
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Provider Name | MARK E KING PA
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Gender | Male
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 04/03/2012
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Provider Practice Location Address
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Address Line | 1401 SUDDERTH DR
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City | RUIDOSO
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State | NM
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Zip | 88345-6104
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Country | US
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Telephone | 575-257-7712
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Fax | 575-257-4513
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Provider Business Mailing Address
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Address Line | 1401 SUDDERTH DR
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City | RUIDOSO
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State | NM
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Zip | 88345-6104
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Country | US
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Telephone | 575-257-7712
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Fax | 575-257-4513
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 10003262
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 95-PA19
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License Number State | NM
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