Individual
DARRELL L KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
500 W. FORT STREET, BOISE VA, BOISE, ID 83702-4501
(208) 422-1136
(208) 422-1083
Mailing address
500 W. FORT STREET, BOISE VA, BOISE, ID 83702-4501
(208) 422-1136
(208) 422-1083
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA235
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010141117
BCBS
ID
01
—
000010141122
BCBS
ID
05
—
805341400
—
ID
01
—
970029609
RR MEDICARE
ID
01
—
PADA5
BCBS
ID
01
—
PADB3
BCBS
ID
Enumeration date
10/24/2005
Last updated
02/06/2012
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