Basic Information
| Provider Information | |||||||||
| NPI: | 1417049396 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | MARK | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2550 UNIVERSITY AVE W STE 110N | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551142001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516025309 | ||||||||
| FaxNumber: | 6512226786 | ||||||||
| Practice Location | |||||||||
| Address1: | 480 OSBORNE RD NE | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | FRIDLEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554322281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7637861620 | ||||||||
| FaxNumber: | 7637803099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 02/21/2018 | ||||||||
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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 | 207RX0202X | 45762 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | PREFERRED ONE | 01 | MN | 963001035165 | OTHER | 369232900 | 05 | MN | MEDICAID | MEDICA | 01 | MN | 3600374 | OTHER | SELECT CARE | 01 | MN | 3600374 | OTHER | 171840 | 01 | MN | UCARE | OTHER | BLUE CROSS | 01 | MN | 043G4KI | OTHER | HEALTH PARTNERS | 01 | MN | HP39070 | OTHER | COMMERCIAL | 01 | MN | 410729979 | OTHER |