Physician Compare National (NPI:1639239692)

HEALTHCARE PROVIDER: CLINTON ALLEN KING MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1639239692
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5597941617
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110525000242
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KING
	Individual professional last name
Provider First Name	CLINTON
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	MEHARRY MEDICAL COLLEGE SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1973
	Individual professional's medical school graduation year
Primary Specialty	DERMATOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	10657 VISTA DEL SOL DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE A
	Group Practice or individual's line 2 address
City	EL PASO
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	799354504
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9155983943
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	M