Provider Demographics
NPI:1184612152
Name:KING, EDWARD THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:THOMAS
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 30243
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-0005
Mailing Address - Country:US
Mailing Address - Phone:405-330-0830
Mailing Address - Fax:
Practice Address - Street 1:8941 ENTRANCE RD A, BLDG 3334
Practice Address - Street 2:
Practice Address - City:TINKER AFB
Practice Address - State:OK
Practice Address - Zip Code:73145-3065
Practice Address - Country:US
Practice Address - Phone:405-582-6836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK135902083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine