MEDICARE: ANNAH M KING OTR/L, CHT

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	174400000X	Specialist	106824	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	106824	OTHER	TX	STATE LICENSE#

General Provider Information

NPI Number	:	1225028988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNAH M KING OTR/L, CHT

Provider Business Mailing Address
First Line	:	3600 GASTON AVE
Second Line	:	SUITE 450
City	:	DALLAS
State	:	TX
Zip	:	75246-1800
Country	:	US
Telephone Number	:	214-823-5351
Fax Number	:	214-823-2060

Provider Business Practice Location Address
First Line	:	3600 GASTON AVE
Second Line	:	SUITE 450
City	:	DALLAS
State	:	TX
Zip	:	75246-1800
Country	:	US
Telephone Number	:	214-823-5351
Fax Number	:	214-823-2060

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	09/24/2009

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