Provider Demographics
NPI:1609872704
Name:KING, PAUL D (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 S NEW BALLAS RD STE 1200
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8221
Mailing Address - Country:US
Mailing Address - Phone:314-251-2880
Mailing Address - Fax:
Practice Address - Street 1:615 S NEW BALLAS RD STE 1200
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8221
Practice Address - Country:US
Practice Address - Phone:314-251-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN49489207RG0100X
MS22349207RG0100X
MOR1647207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6326V54782OtherHEALTHCARE USA
MS1732416OtherFIRST HEALTH
MO228719OtherGROUP HEALTH PLANS
MO201191032OtherTRICARE
MO4206923OtherAETNA
MO514183OtherPRIVATE HEALTHCARE SYSTEM
MO3089254005OtherCIGNA
MO194002OtherBLUE CROSS BLUE SHIELD
MO126586OtherHEALTHLINK
MO203167911Medicaid
MO4206923OtherAETNA
MO201191032OtherTRICARE
MS1732416OtherFIRST HEALTH
MO000014738Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER