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General NPI Number Information
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NPI Number | 1457557829
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Entity Type | Individual
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Provider Name | ROBERT LAWRENCE KING MD
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Gender | Male
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 11/09/2012
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Provider Practice Location Address
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Address Line | 714 N SENATE AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-3763
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Country | US
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Telephone | 317-432-3134
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Fax |
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Provider Business Mailing Address
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Address Line | 5211 PRIMROSE AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46220-3314
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Country | US
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Telephone | 317-251-8206
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Fax |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 11013296A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 01066161A
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License Number State | IN
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