Provider Demographics
NPI:1629395124
Name:KING, JULIE LANE (DO)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:LANE
Last Name:KING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:LANE
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:401 E SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-5679
Mailing Address - Country:US
Mailing Address - Phone:620-384-4041
Mailing Address - Fax:
Practice Address - Street 1:401 E SPRUCE ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5679
Practice Address - Country:US
Practice Address - Phone:620-384-4041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-36494208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist