Provider Demographics
NPI:1124009352
Name:KING, JON A (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:A
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2320 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1303
Mailing Address - Country:US
Mailing Address - Phone:602-258-9900
Mailing Address - Fax:602-258-9904
Practice Address - Street 1:9321 W THOMAS RD STE 325
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3396
Practice Address - Country:US
Practice Address - Phone:623-936-5406
Practice Address - Fax:623-936-5479
Is Sole Proprietor?:No
Enumeration Date:2005-11-05
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25175208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ387052Medicaid
AZ387052Medicaid
Z111889Medicare PIN
AZ119763Medicare PIN
AZG44839Medicare UPIN