Provider Demographics
NPI:1285831164
Name:KING, LAUREN BUSH (MD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:BUSH
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15945 CLAYTON RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2490
Mailing Address - Country:US
Mailing Address - Phone:636-256-5130
Mailing Address - Fax:636-256-5147
Practice Address - Street 1:15945 CLAYTON RD
Practice Address - Street 2:SUITE 340
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-2490
Practice Address - Country:US
Practice Address - Phone:636-256-5130
Practice Address - Fax:636-256-5147
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2007019030207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine