Basic Information
| Provider Information | |||||||||
| NPI: | 1073519484 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | CURTIS | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4700 FORUM BLVD | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652035654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5734494936 | ||||||||
| FaxNumber: | 5734496795 | ||||||||
| Practice Location | |||||||||
| Address1: | 1021 E HIGHWAY 22 | ||||||||
| Address2: | |||||||||
| City: | CENTRALIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652401183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736825588 | ||||||||
| FaxNumber: | 5736821539 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2005 | ||||||||
| LastUpdateDate: | 10/26/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 157489 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 129223 | 01 | MO | BLUE CROSS BLUE SHIELD | OTHER | 434648 | 01 | MO | HEALTHLINK | OTHER | 122972 | 01 | MO | GROUP HEALTH PLANS | OTHER | 20758 | 01 | MO | HEALTHCARE USA IND | OTHER | 42835 | 01 | MO | HEALTHCARE USA GRP | OTHER | H22808 | 01 | MO | MERCY | OTHER | 0102128 | 01 | MO | UNITED HEALTHCARE | OTHER |