Provider Demographics
NPI:1851340285
Name:KING, CRAIG KENT (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:KENT
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 1:3209 N 4TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5145
Mailing Address - Country:US
Mailing Address - Phone:903-757-4662
Mailing Address - Fax:
Practice Address - Street 1:3209 N 4TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5145
Practice Address - Country:US
Practice Address - Phone:903-757-4662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6820207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089528602Medicaid
TX180002305OtherRAILROAD MEDICARE
TX089528602Medicaid
TXC17886Medicare UPIN