Provider Demographics
NPI:1316972938
Name:KING, JOSEPH III (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:KING
Suffix:III
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 1:816 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76060-5604
Mailing Address - Country:US
Mailing Address - Phone:972-809-0852
Mailing Address - Fax:
Practice Address - Street 1:816 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:KENNEDALE
Practice Address - State:TX
Practice Address - Zip Code:76060-5604
Practice Address - Country:US
Practice Address - Phone:972-809-0852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7949207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163732403Medicaid
TX163732404Medicaid
TX163732405Medicaid
TX163732407Medicaid
TX163732404Medicaid
TX8D8816Medicare ID - Type Unspecified
TX163732407Medicaid
TXTXB121904Medicare PIN
TXTXB109956Medicare PIN