Provider Demographics
NPI:1861594970
Name:KING, MARTA H (MD)
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:H
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 1:2600 WILSON
Mailing Address - Street 2:PO BOX 698
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301-0698
Mailing Address - Country:US
Mailing Address - Phone:406-233-3937
Mailing Address - Fax:406-233-2522
Practice Address - Street 1:2600 WILSON ST
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-5094
Practice Address - Country:US
Practice Address - Phone:406-233-3937
Practice Address - Fax:406-233-2522
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7163207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT10421OtherBLUE CROSS BLUE SHIELD
MT71500Medicaid
MT0984180001Medicare NSC
MT10421OtherBLUE CROSS BLUE SHIELD