Provider Demographics
NPI:1013058536
Name:KING, JOSEPH D (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:D
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-815-1196
Mailing Address - Fax:601-984-5939
Practice Address - Street 1:4821 MERLOT AVENUE
Practice Address - Street 2:SUITE 210
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051
Practice Address - Country:US
Practice Address - Phone:972-867-3627
Practice Address - Fax:817-421-7560
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS25782207LP3000X
TXL6985207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160325001Medicaid
TX8B1007Medicare PIN
TX160325001Medicaid