Individual
MARK E KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1401 SUDDERTH DR, RUIDOSO, NM 88345-6104
(575) 257-7712
(575) 257-4513
Mailing address
1401 SUDDERTH DR, RUIDOSO, NM 88345-6104
(575) 257-7712
(575) 257-4513
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
10003262
WA
363AM0700X
Medical Physician Assistant
Primary
95-PA19
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0220796
LIWA
WA
01
—
3016KI
BSWA
WA
01
—
605960011
USDLAB
WA
05
—
8464794
—
WA
Enumeration date
09/27/2006
Last updated
04/03/2012
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