Provider Demographics
NPI:1346009909
Name:KING, ALEXIS (DO)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:KING
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 HIGHLAND VIEW DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-6730
Mailing Address - Country:US
Mailing Address - Phone:210-287-1955
Mailing Address - Fax:
Practice Address - Street 1:MSC10 5620 1 UNIVERSITY OF NEW MEXICO
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-3618
Practice Address - Country:US
Practice Address - Phone:505-272-3160
Practice Address - Fax:505-272-9427
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program