MEDICARE: DR. VERNON JAMES 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	2085R0001X	Radiation Oncology Physician	39338	CO

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	841340905004	OTHER	CO	ROCKY MOUNTAIN

General Provider Information

NPI Number	:	1649278003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VERNON JAMES KING M.D.

Provider Business Mailing Address
First Line	:	PO BOX 62
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81502-0062
Country	:	US
Telephone Number	:	970-298-2273
Fax Number	:	970-298-1809

Provider Business Practice Location Address
First Line	:	750 WELLINGTON AVE
Second Line	:	ST. MARY'S MEDICAL PAVILION, RADIATION ONCOLOGY
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-6132
Country	:	US
Telephone Number	:	970-298-7500
Fax Number	:	970-298-7262

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

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	01/14/2014

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