Basic Information
| Provider Information | |||||||||
| NPI: | 1811054018 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1225 CAMPBELL WAY STE 201 | ||||||||
| Address2: | |||||||||
| City: | BREMERTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983103323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603771355 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1225 CAMPBELL WAY STE 201 | ||||||||
| Address2: | |||||||||
| City: | BREMERTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983103323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603771355 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2007 | ||||||||
| LastUpdateDate: | 12/04/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | MD00038679 | WA | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 8323230 | 05 | WA | MEDICAID | 263080 | 01 | INTERNAL ID-MOTOR VEHICLE ID | OTHER | 1032073 | 05 | WA | MEDICAID |