Provider Demographics
NPI:1639162530
Name:KING, THOMAS R (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11125 DUNN RD
Mailing Address - Street 2:STE 204
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6132
Mailing Address - Country:US
Mailing Address - Phone:314-839-5522
Mailing Address - Fax:314-839-5351
Practice Address - Street 1:11125 DUNN RD
Practice Address - Street 2:STE 204
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6132
Practice Address - Country:US
Practice Address - Phone:314-839-5522
Practice Address - Fax:314-839-5351
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR7F82207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
6327V8816OtherHCUSA
E36005OtherMERCY
3156370OtherCIGNA
42693V30946OtherHLTHPART
000000013834OtherESSENCE
IL060067901OtherILRRMCR
MO060067902OtherMORRMCR
MO206707606Medicaid
4334049OtherAETNA
O21267OtherJFMOLLOY/FMH
MO20502OtherMOBS/BLCHOICE
431098908OtherTRICARE
123148OtherHLNK
2500128OtherUNC
1955V3831OtherGHP/CMR
O21267OtherJFMOLLOY/FMH
123148OtherHLNK
MO060067902OtherMORRMCR
MO206707606Medicaid
MO098050163Medicare PIN