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NPI Code Detail

MEDICARE: DARRELL L KING PA

MEDICARE: DARRELL L KING PA
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
1363A00000XPhysician AssistantPA235ID

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1970029609OTHERIDRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2000010141117OTHERIDBCBS
3PADA5OTHERIDBCBS
4000010141122OTHERIDBCBS
5PADB3OTHERIDBCBS
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770573644
Entity Type Code : Individual
Provider Name (Legal Business Name) : DARRELL L KING PA
Provider Business Mailing Address
First Line : 500 W. FORT STREET
Second Line : BOISE VA
City : BOISE
State : ID
Zip : 83702-4501
Country : US
Telephone Number : 208-422-1136
Fax Number : 208-422-1083
Provider Business Practice Location Address
First Line : 500 W. FORT STREET
Second Line : BOISE VA
City : BOISE
State : ID
Zip : 83702-4501
Country : US
Telephone Number : 208-422-1136
Fax Number : 208-422-1083
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2005
Last Update Date : 02/06/2012

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Directions to “ DARRELL L KING PA” Practice Location

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