Provider Demographics
NPI:1225022601
Name:KING, ANTHONY HAMMOND (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:HAMMOND
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 1:1100 TRANCAS ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2900
Mailing Address - Country:US
Mailing Address - Phone:707-251-1850
Mailing Address - Fax:707-226-1502
Practice Address - Street 1:1100 TRANCAS STREET
Practice Address - Street 2:SUITE 209
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558
Practice Address - Country:US
Practice Address - Phone:707-251-1850
Practice Address - Fax:707-226-1502
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48070207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A480700Medicaid
CA00A480700Medicare ID - Type Unspecified
E63935Medicare UPIN
CA00A480700Medicaid