Individual
GLEN W. KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
6151 N MAIN STREET RD, WEBB CITY, MO 64870-8189
(417) 781-0408
(417) 556-5377
Mailing address
6151 N MAIN STREET RD, WEBB CITY, MO 64870-8189
(417) 781-0408
(417) 556-5377
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
113228
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558303784
—
MO
05
—
200090170A
—
OK
01
—
P00817803
RAIL ROAD MEDICARE
MO
Enumeration date
06/12/2006
Last updated
04/06/2016
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