Provider Demographics
NPI:1962508218
Name:KING, JEFFREY C (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:C
Last Name:KING
Suffix:
Gender:
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:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:185 HARRY S TRUMAN PKWY STE 120
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7580
Practice Address - Country:US
Practice Address - Phone:410-224-4442
Practice Address - Fax:410-244-4442
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023041280207VM0101X
OH35068823207VM0101X
IAMD-46693207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000571736OtherANTHEM
KY50020258OtherPASSPORT FOUNDATION PCP
KY6493951500Medicaid
KY0000000571093OtherANTHEM
KY50019626OtherPASSPORT PSC SPECIALITY
IN200904930Medicaid
KY50020257OtherPASSPORT FOUNDATION SPECIALITY
KY0000000571093OtherANTHEM
IN200904930Medicaid
KY50020258OtherPASSPORT FOUNDATION PCP