Individual
DR. MARK D. KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
455 S KIRKWOOD RD, KIRKWOOD, MO 63122-6119
(636) 256-8644
Mailing address
17505 SUMMIT VIEW PLACE RDG, WILDWOOD, MO 63038-2105
(636) 458-6285
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R1P80
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00348648
RR MEDICARE
MO
Enumeration date
07/20/2006
Last updated
02/09/2010
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