MEDICARE: LUCAS RAYMOND KING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	DR.0058676	CO
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	C185826	CA
3	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	DR.0058676	CO
4	207X00000X	Orthopaedic Surgery Physician	MD.35064	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114216421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCAS RAYMOND KING

Provider Business Mailing Address
First Line	:	525 DOYLE PARK DR STE 101
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-4562
Country	:	US
Telephone Number	:	707-525-6620
Fax Number	:	707-522-1279

Provider Business Practice Location Address
First Line	:	525 DOYLE PARK DR STE 101
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-4562
Country	:	US
Telephone Number	:	707-525-6620
Fax Number	:	707-522-1279

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2011
Last Update Date	:	12/09/2025

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Directions to “ LUCAS RAYMOND KING ” Practice Location

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