Provider Demographics
NPI:1194817411
Name:KING, MAURICE L (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:L
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 1:4950 ESSEN LANE
Mailing Address - Street 2:ATTN: KRISTI SIEMANN
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3482
Mailing Address - Country:US
Mailing Address - Phone:225-215-1311
Mailing Address - Fax:225-215-1380
Practice Address - Street 1:4950 ESSEN LANE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3482
Practice Address - Country:US
Practice Address - Phone:225-767-0847
Practice Address - Fax:225-766-1417
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0182402085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1384844Medicaid
LAE08523Medicare UPIN
LA5J9067290Medicare PIN