Provider Demographics
NPI:1104408327
Name:KING, DONALD T JR (NBC-HWC)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:T
Last Name:KING
Suffix:JR
Gender:M
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3543 CASCADE CT
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-6501
Mailing Address - Country:US
Mailing Address - Phone:978-319-0377
Mailing Address - Fax:
Practice Address - Street 1:3543 CASCADE CT
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-6501
Practice Address - Country:US
Practice Address - Phone:978-319-0377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date: