Basic Information
| Provider Information | |||||||||
| NPI: | 1528333010 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DR. KING SCOPE CLINIC, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 WILLAGILLESPIE RD | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974012178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413430952 | ||||||||
| FaxNumber: | 5413438034 | ||||||||
| Practice Location | |||||||||
| Address1: | 2699 N 17TH ST | ||||||||
| Address2: | |||||||||
| City: | COOS BAY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974202134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412697358 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2012 | ||||||||
| LastUpdateDate: | 03/15/2012 | ||||||||
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| AuthorizedOfficialLastName: | KING | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | D. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5412697358 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD13871 | OR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.