MEDICARE: DR. CRAIG KENT KING MD

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	207W00000X	Ophthalmology Physician	F6820	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	180002305	OTHER	TX	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

General Provider Information

NPI Number	:	1851340285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG KENT KING MD

Provider Business Mailing Address
First Line	:	3209 N 4TH ST
Second Line	:	SUITE 100
City	:	LONGVIEW
State	:	TX
Zip	:	75605-5145
Country	:	US
Telephone Number	:	903-757-4662
Fax Number	:

Provider Business Practice Location Address
First Line	:	3209 N 4TH ST
Second Line	:	SUITE 100
City	:	LONGVIEW
State	:	TX
Zip	:	75605-5145
Country	:	US
Telephone Number	:	903-757-4662
Fax Number	:

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	05/17/2010

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Directions to “ DR. CRAIG KENT KING MD” Practice Location

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