MEDICARE: DR. TREVOR PAUL KING M.D.

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	207Q00000X	Family Medicine Physician	2005032732	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00374043	OTHER		RAILROAD MEDICARE
4	P01135224	OTHER	MO	RAILROAD MEDICARE

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487698445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TREVOR PAUL KING M.D.

Provider Business Mailing Address
First Line	:	3430 W EDGEWOOD DR
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-6961
Country	:	US
Telephone Number	:	573-635-0233
Fax Number	:

Provider Business Practice Location Address
First Line	:	3430 W EDGEWOOD DR
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-6961
Country	:	US
Telephone Number	:	573-635-0233
Fax Number	:

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	02/20/2024

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