Provider Demographics
NPI:1609806876
Name:KING, THOMAS B (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:B
Last Name:KING
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4045 WADSWORTH BLVD
Mailing Address - Street 2:STE 308
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4642
Mailing Address - Country:US
Mailing Address - Phone:720-328-6119
Mailing Address - Fax:303-432-1936
Practice Address - Street 1:4045 WADSWORTH BLVD
Practice Address - Street 2:STE 308
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4642
Practice Address - Country:US
Practice Address - Phone:720-328-6119
Practice Address - Fax:303-432-1936
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2010-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO194302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01194307Medicaid
COCO304834Medicare PIN
CO01194307Medicaid
COC49421Medicare PIN