Provider Demographics
NPI:1457441586
Name:KING, MAGGIE J (MD)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:J
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:J
Other - Last Name:CROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 7287
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-7287
Mailing Address - Country:US
Mailing Address - Phone:541-447-6263
Mailing Address - Fax:541-447-4698
Practice Address - Street 1:384 SE COMBS FLAT RD STE 1200
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-2562
Practice Address - Country:US
Practice Address - Phone:541-447-6263
Practice Address - Fax:541-447-8475
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26910207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORMD26910OtherLICENSE