Provider Demographics
NPI:1316918964
Name:KING, DAVID L (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
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 1:612 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-4702
Mailing Address - Country:US
Mailing Address - Phone:479-785-2431
Mailing Address - Fax:
Practice Address - Street 1:1301 S E ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4716
Practice Address - Country:US
Practice Address - Phone:479-785-2431
Practice Address - Fax:479-494-7787
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1430207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
9233469001OtherCIGNA
07060048300OtherQUALCHOICE
AR132389001Medicaid
AR5K581OtherBC/BS
2287962OtherUNITED HEALTH CARE
5334029OtherAETNA
ARP00416960OtherRR MEDICARE
OK200113550AMedicaid
AR2287962OtherUNITED HEALTH CARE
AR132389001Medicaid