Provider Demographics
NPI:1689702359
Name:KING, JOHN BRADFORD (OPF)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:BRADFORD
Last Name:KING
Suffix:
Gender:M
Credentials:OPF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 NOBLIN RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-2415
Mailing Address - Country:US
Mailing Address - Phone:919-878-7183
Mailing Address - Fax:919-878-7151
Practice Address - Street 1:2521 NOBLIN RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-2415
Practice Address - Country:US
Practice Address - Phone:919-878-7183
Practice Address - Fax:919-878-7151
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC36308222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist