Provider Demographics
NPI:1962508218
Name:KING, JEFFREY C (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:C
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:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:1440 PLEASANT ST STE 1
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-1728
Practice Address - Country:US
Practice Address - Phone:515-241-8383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023041280207VM0101X
OH35068823207VM0101X
IAMD-46693207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50019626OtherPASSPORT PSC SPECIALITY
KY50020258OtherPASSPORT FOUNDATION PCP
KY6493951500Medicaid
KY000000571736OtherANTHEM
IN200904930Medicaid
KY0000000571093OtherANTHEM
KY50020257OtherPASSPORT FOUNDATION SPECIALITY
KY0000000571093OtherANTHEM
IN200904930Medicaid
KY50020258OtherPASSPORT FOUNDATION PCP