Provider Demographics
NPI:1457427817
Name:KING, VALTON N (DO)
Entity type:Individual
Prefix:
First Name:VALTON
Middle Name:N
Last Name:KING
Suffix:
Gender:M
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:PO BOX 970188
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-0188
Mailing Address - Country:US
Mailing Address - Phone:801-377-5467
Mailing Address - Fax:801-224-7100
Practice Address - Street 1:839 E 1200 S
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-6603
Practice Address - Country:US
Practice Address - Phone:801-224-0891
Practice Address - Fax:801-224-7100
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT91-180362-1204208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT006537001Medicare ID - Type Unspecified
UTE98406Medicare UPIN