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General NPI Number Information
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NPI Number | 1821101023
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Entity Type | Organization
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Legal Business Name | JONATHAN S KING MD PC
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 08/27/2014
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Provider Practice Location Address
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Address Line | 1107 W IRONWOOD DR
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2604
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Country | US
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Telephone | 208-667-7459
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Fax | 208-667-2631
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Provider Business Mailing Address
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Address Line | 1107 W IRONWOOD DR
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2604
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Country | US
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Telephone | 208-667-7459
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Fax | 208-667-2631
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JONATHAN S KING
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Credential | M.D.
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Telephone | 208-667-7459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | M9264
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License Number State | ID
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