Provider Demographics
NPI:1114931847
Name:KING, WINIFRED RENE (MD)
Entity Type:Individual
Prefix:MS
First Name:WINIFRED
Middle Name:RENE
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14637 PEBBLE BEND DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77068-2922
Mailing Address - Country:US
Mailing Address - Phone:936-224-7990
Mailing Address - Fax:936-224-3154
Practice Address - Street 1:14637 PEBBLE BEND DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-2922
Practice Address - Country:US
Practice Address - Phone:936-224-7990
Practice Address - Fax:936-224-3154
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5295208D00000X, 207P00000X
FL73137204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189062602Medicaid
TX189062604Medicaid
TX8R8316OtherBCBS
TX8K0595Medicare PIN
TX8K0594Medicare PIN
TX8R8316OtherBCBS
TXD94026Medicare UPIN
TX189062604Medicaid
TX189062602Medicaid