Provider Demographics
NPI:1417049396
Name:KING, DAVID MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARK
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2550 UNIVERSITY AVE W STE 110N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-2001
Mailing Address - Country:US
Mailing Address - Phone:651-602-5309
Mailing Address - Fax:651-222-6786
Practice Address - Street 1:480 OSBORNE RD NE
Practice Address - Street 2:SUITE 220
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-2281
Practice Address - Country:US
Practice Address - Phone:763-786-1620
Practice Address - Fax:763-780-3099
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN45762207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNPREFERRED ONEOther963001035165
MN369232900Medicaid
MNMEDICAOther3600374
MNSELECT CAREOther3600374
MN171840OtherUCARE
MNBLUE CROSSOther043G4KI
MNHEALTH PARTNERSOtherHP39070
MNCOMMERCIALOther410729979
MNHEALTH PARTNERSOtherHP39070
MNSELECT CAREOther3600374