Provider Demographics
NPI:1811054018
Name:KING, ROBERT CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:CHRISTOPHER
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 1:1225 CAMPBELL WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3323
Mailing Address - Country:US
Mailing Address - Phone:360-377-1355
Mailing Address - Fax:
Practice Address - Street 1:1225 CAMPBELL WAY STE 201
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3323
Practice Address - Country:US
Practice Address - Phone:360-377-1355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038679208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8323230Medicaid
263080OtherINTERNAL ID-MOTOR VEHICLE ID
WA1032073Medicaid
263080OtherINTERNAL ID-MOTOR VEHICLE ID
AB28889Medicare ID - Type Unspecified