Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 12569 | KY |
NPI | 1144282815 |
---|---|
Provider Name | Malcolm H King |
First Address | Ashland, KY 41101-2873 |
Second Address | Ashland, KY 41101-2873 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000045301 | ANTHEM/BLUE CROSS/BLUE SH (01) | KY |
64125693 | (05) | KY |
C68076 | (02) | KY |
K001463 | CHAMPUS (01) | KY |