Basic Information
| Provider Information | |||||||||
| NPI: | 1629364484 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | REID | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 13579 | ||||||||
| Address2: | |||||||||
| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196123579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4846281324 | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 E NICOLLET BLVD | ||||||||
| Address2: | |||||||||
| City: | BURNSVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553375714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9828922000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2011 | ||||||||
| LastUpdateDate: | 11/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD451345 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MT198879 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 64475 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.