Provider Demographics
NPI:1760630321
Name:KING, PHOEBE CONSUE (MD)
Entity type:Individual
Prefix:DR
First Name:PHOEBE
Middle Name:CONSUE
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9450 S 1300 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-5555
Mailing Address - Country:US
Mailing Address - Phone:801-501-2142
Mailing Address - Fax:801-501-6210
Practice Address - Street 1:9450 S 1300 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-5555
Practice Address - Country:US
Practice Address - Phone:801-501-2142
Practice Address - Fax:801-501-6210
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13213014-1205207RC0200X, 207RP1001X
TXN7553207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX282191001Medicaid
TX282191003Medicaid
TX282191003Medicaid
TX387729YM6WMedicare PIN