MEDICARE: DR. JOHN WAYNE KING D.O.

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	MB71227	NJ

General Provider Information

NPI Number	:	1730129800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN WAYNE KING D.O.

Provider Business Mailing Address
First Line	:	2124 MORRIS AVE
Second Line	:	SUITE 203
City	:	UNION
State	:	NJ
Zip	:	07083-6006
Country	:	US
Telephone Number	:	908-686-1488
Fax Number	:	908-687-7886

Provider Business Practice Location Address
First Line	:	2124 MORRIS AVE
Second Line	:	SUITE 203
City	:	UNION
State	:	NJ
Zip	:	07083-6006
Country	:	US
Telephone Number	:	908-686-1488
Fax Number	:	908-687-7886

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	07/08/2007

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