Individual
DR. JACK DENNIS KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3094 W MARKET ST, SUITE 103, FAIRLAWN, OH 44333-3626
(330) 836-9397
(330) 836-0907
Mailing address
3094 W MARKET ST, SUITE 103, FAIRLAWN, OH 44333-3626
(330) 836-9397
(330) 836-0907
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
35044194
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0420306 OH
—
OH
Enumeration date
05/17/2006
Last updated
03/04/2008
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