Provider Demographics
NPI:1316940919
Name:KING, CLAIRE E (MD)
Entity type:Individual
Prefix:DR
First Name:CLAIRE
Middle Name:E
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:E
Other - Last Name:INGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1375 N 10TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:STAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97383-2099
Mailing Address - Country:US
Mailing Address - Phone:503-769-7546
Mailing Address - Fax:503-769-8563
Practice Address - Street 1:1375 N 10TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:STAYTON
Practice Address - State:OR
Practice Address - Zip Code:97383-2099
Practice Address - Country:US
Practice Address - Phone:503-769-7151
Practice Address - Fax:503-769-8563
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41527207Q00000X
ORMD27164207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO42170541Medicaid
OR218268Medicaid
OR218268Medicaid
R141706Medicare PIN