JOHN KING PHD

Clinical Neuropsychologist

Albuquerque, New Mexico

Provider NPI: 1811977325

Provider Information:
 JOHN  KING PHD
Gender: M
Not Sole Proprietor

Practice Location:
3400 CONSTITUTION AVE NE STE C  ALBUQUERQUE, NM 87106 US
Tel: 505-944-5383  Fax: 505-299-4740

Business Mailing Address:
3400 CONSTITUTION AVE NE STE C  ALBUQUERQUE, NM 87106 US
Tel: 505-944-5383  Fax: 505-299-4740

Entity Type: Individual

Taxonomy:

Primary	Code	Category/Description	State	License Number
N	103G00000X	Behavioral Health & Social Service Providers Clinical Neuropsychologist	IL	71006364
Y	103G00000X	Behavioral Health & Social Service Providers Clinical Neuropsychologist	NM	0969

Other Provider Identifiers:

Issuer	Number	State	Type
	71006364	IL	05

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin

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