Provider Demographics
NPI:1649278003
Name:KING, VERNON JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:VERNON
Middle Name:JAMES
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81502-0062
Mailing Address - Country:US
Mailing Address - Phone:970-298-2273
Mailing Address - Fax:970-298-1809
Practice Address - Street 1:750 WELLINGTON AVE
Practice Address - Street 2:ST. MARY'S MEDICAL PAVILION, RADIATION ONCOLOGY
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6132
Practice Address - Country:US
Practice Address - Phone:970-298-7500
Practice Address - Fax:970-298-7262
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO393382085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO74950024Medicaid
CO841340905004OtherROCKY MOUNTAIN
F87527Medicare UPIN
CO179038Medicare ID - Type Unspecified