Basic Information
| Provider Information | |||||||||
| NPI: | 1194037713 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | KODY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 785 | ||||||||
| Address2: | |||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735020785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803579984 | ||||||||
| FaxNumber: | 5803573277 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 NW 31ST ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735056100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803573671 | ||||||||
| FaxNumber: | 5803571256 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2010 | ||||||||
| LastUpdateDate: | 02/02/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 5101018980 | MI | N | Allopathic & Osteopathic Physicians | General Practice | 390200000X | 5096 | OK | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207X00000X | 2919 | TN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.