Provider Demographics
NPI:1376603712
Name:KING, WILLIAM RUSSELL (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RUSSELL
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 1:8101 PARALLEL PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-2067
Mailing Address - Country:US
Mailing Address - Phone:913-299-9200
Mailing Address - Fax:913-299-9210
Practice Address - Street 1:8101 PARALLEL PKWY
Practice Address - Street 2:STE 100
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-2010
Practice Address - Country:US
Practice Address - Phone:913-299-9200
Practice Address - Fax:913-299-9210
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-24277207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100139360BMedicaid
KSM723590Medicare ID - Type Unspecified