Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | DR.0058676 | CO |
N | 207X00000X | Orthopaedic Surgeon | MD.35064 | AL |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | DR.0058676 | CO |
NPI | 1114216421 |
---|---|
Provider Name | Lucas Raymond King |
First Address | Denver, CO 80256-0825 |
Second Address | Pueblo, CO 81008-2215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2011 |
Last Update Date | 14/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9000148102 | (05) | CO |