Provider Demographics
NPI:1518130996
Name:KING, LAUREN COOPER (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:COOPER
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:ROBERTS
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1407 UNION AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3641
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:930 MADISON AVE STE 534
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38163
Practice Address - Country:US
Practice Address - Phone:901-448-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK31223207ZH0000X, 207ZP0102X
TN49235207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03936334Medicaid
TNQ031052Medicaid