Provider Demographics
NPI:1548586878
Name:KING, PAUL ROBERT (IDMT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ROBERT
Last Name:KING
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2190 27TH ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-1611
Mailing Address - Country:US
Mailing Address - Phone:319-377-3314
Mailing Address - Fax:
Practice Address - Street 1:2190 27TH ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-1611
Practice Address - Country:US
Practice Address - Phone:319-377-3314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians