MEDICARE: DR. DAVID JONATHAN 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	207X00000X	Orthopaedic Surgery Physician	2007004403	MO
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	44494	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00419014	OTHER	MO	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0941063	OTHER	MO	CIGNA
3	318057	OTHER	MO	COVENTRY
4	219012	OTHER	IL	ANTHEM
5	7490838	OTHER	MO	AETNA
6	2771955	OTHER	MO	UNITED HEALTHCARE
7	219012	OTHER	MO	ANTHEM
8	792533	OTHER	MO	HEALTHLINK
9	792533	OTHER	IL	HEALTHLINK

General Provider Information

NPI Number	:	1659484715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID JONATHAN KING M.D.

Provider Business Mailing Address
First Line	:	633 EMERSON ROAD
Second Line	:	SUITE 100
City	:	CREVE COUER
State	:	MO
Zip	:	63141-7134
Country	:	US
Telephone Number	:	314-991-2113
Fax Number	:	314-991-2115

Provider Business Practice Location Address
First Line	:	633 EMERSON RD
Second Line	:	SUITE 100
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-6739
Country	:	US
Telephone Number	:	314-991-2113
Fax Number	:	314-991-2115

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	12/02/2015

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Directions to “ DR. DAVID JONATHAN KING M.D.” Practice Location

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