Provider Demographics
NPI:1376846121
Name:STUART W. KING, M.D., LLC
Entity Type:Organization
Organization Name:STUART W. KING, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-224-0891
Mailing Address - Street 1:PO BOX 970188
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-0188
Mailing Address - Country:US
Mailing Address - Phone:801-224-0891
Mailing Address - Fax:801-224-7100
Practice Address - Street 1:839 E 1200 S
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-6603
Practice Address - Country:US
Practice Address - Phone:801-224-0891
Practice Address - Fax:801-224-7100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty