Provider Demographics
NPI:1144228966
Name:KING, JEFFREY K (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:K
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7440 SOUTH 91ST STREET
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9797
Mailing Address - Country:US
Mailing Address - Phone:402-489-6555
Mailing Address - Fax:402-328-3770
Practice Address - Street 1:3515 RICHMOND CIRCLE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4965
Practice Address - Country:US
Practice Address - Phone:308-381-8636
Practice Address - Fax:308-381-8622
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21858207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47070592300Medicaid
NE47070592305Medicaid
NE10026072500Medicaid
KS200578840AMedicaid
NE47070592313Medicaid
NE10026072400Medicaid
NE10026072300Medicaid
IA3202488Medicaid
NE47070592301Medicaid
NE47070592306Medicaid
IA0202488Medicaid
NE47070592302Medicaid
NEP00649349Medicare PIN
NE47070592300Medicaid
KS200578840AMedicaid
NE10026072300Medicaid
NE47070592313Medicaid