Provider Demographics
NPI:1235154808
Name:KING, RONALD L (PA)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:L
Last Name:KING
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 873236
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98687-3236
Mailing Address - Country:US
Mailing Address - Phone:360-882-6997
Mailing Address - Fax:360-882-4132
Practice Address - Street 1:3200 SE 164TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-1107
Practice Address - Country:US
Practice Address - Phone:360-882-6997
Practice Address - Fax:360-882-4132
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004115363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP96842Medicare UPIN