Provider Demographics
NPI:1285674119
Name:KING, JOHN C (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 HIGHWAY 654
Mailing Address - Street 2:
Mailing Address - City:GHEENS
Mailing Address - State:LA
Mailing Address - Zip Code:70355-2103
Mailing Address - Country:US
Mailing Address - Phone:985-446-5210
Mailing Address - Fax:985-446-8327
Practice Address - Street 1:4608 HIGHWAY 1
Practice Address - Street 2:SUITE 230
Practice Address - City:RACELAND
Practice Address - State:LA
Practice Address - Zip Code:70394-2623
Practice Address - Country:US
Practice Address - Phone:985-446-5210
Practice Address - Fax:985-446-8327
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08070R207R00000X
LAMD 08070R207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1900G5312ZOtherBC OF LA
LA1939293Medicaid
LA290004895OtherRAILROAD MEDICARE
LAC73575Medicare UPIN
LA1939293Medicaid