Provider Demographics
NPI:1780634659
Name:KING, JOHN M (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
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 1:357 GENESEE ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-2658
Mailing Address - Country:US
Mailing Address - Phone:315-363-4651
Mailing Address - Fax:315-363-2821
Practice Address - Street 1:357 GENESEE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2658
Practice Address - Country:US
Practice Address - Phone:315-363-4651
Practice Address - Fax:315-363-2821
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-31900207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01861196Medicaid
KS200371360CMedicaid
KS200371360CMedicaid
KS110607002Medicare PIN
NY01861196Medicaid