Provider Demographics
NPI:1801946231
Name:KING, MATTHEW KYLE (OPA-C)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:KYLE
Last Name:KING
Suffix:
Gender:M
Credentials:OPA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4565 BLARNEY STONE CT
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-2118
Mailing Address - Country:US
Mailing Address - Phone:972-668-3095
Mailing Address - Fax:214-472-8140
Practice Address - Street 1:4565 BLARNEY STONE CT
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-2118
Practice Address - Country:US
Practice Address - Phone:972-668-3095
Practice Address - Fax:214-472-8140
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
607718900OtherDEPARTMENT OF LABOR