Provider Demographics
NPI:1710034921
Name:KING, DORE ANN (LMP)
Entity Type:Individual
Prefix:MS
First Name:DORE
Middle Name:ANN
Last Name:KING
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1281 NE STEEPLE ROCK LN APT HH202
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-6819
Mailing Address - Country:US
Mailing Address - Phone:360-692-3870
Mailing Address - Fax:
Practice Address - Street 1:9301 LINDER WAY NW STE 210
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8396
Practice Address - Country:US
Practice Address - Phone:360-531-1014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022354174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00022354OtherBUSINESS LICENCE
WA503873-05OtherNCTMB NUMBER