Individual
DR. BRADLEY OWEN KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 S BECKHAM AVE, TYLER, TX 75701-1908
(903) 597-0351
(903) 525-9301
Mailing address
1000 S BECKHAM AVE, TYLER, TX 75701-1908
(903) 597-0351
(903) 525-9301
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
L0336
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0372286-04
—
TX
01
—
8F6462
BLUE CROSS
TX
01
—
930120767
RAILROAD MEDICARE
TX
Enumeration date
06/06/2006
Last updated
07/09/2014
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