Provider Demographics
NPI:1346222494
Name:KING, DOUGLAS H (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:H
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:PO BOX 821350
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-0030
Mailing Address - Country:US
Mailing Address - Phone:503-283-5220
Mailing Address - Fax:503-283-9527
Practice Address - Street 1:501 N GRAHAM ST
Practice Address - Street 2:#220
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1654
Practice Address - Country:US
Practice Address - Phone:503-280-3418
Practice Address - Fax:503-284-7885
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD144772080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR057775001OtherBLUE CROSS
WA1053073Medicaid
OR130153Medicaid
OR00WFBXLAMedicare ID - Type Unspecified
D94319Medicare UPIN
OR057775001OtherBLUE CROSS