Provider Demographics
NPI:1053599308
Name:KING, ROBERT THOMAS
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:THOMAS
Last Name:KING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-1294
Mailing Address - Country:US
Mailing Address - Phone:660-886-2975
Mailing Address - Fax:
Practice Address - Street 1:628 E HIGH ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-1294
Practice Address - Country:US
Practice Address - Phone:660-886-2975
Practice Address - Fax:660-886-2975
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health