Provider Demographics
NPI:1982601381
Name:KING, TERESA MOELLER (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:MOELLER
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 ARKANSAS ST STE 215
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1326
Mailing Address - Country:US
Mailing Address - Phone:785-505-2250
Mailing Address - Fax:785-505-5259
Practice Address - Street 1:330 ARKANSAS ST STE 215
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044
Practice Address - Country:US
Practice Address - Phone:785-505-2250
Practice Address - Fax:785-505-5259
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0423563207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100127940AMedicaid
KSE90504Medicare UPIN
KS100127940AMedicaid