Active NPI
Gerald Marlin King, DO
- Family Medicine Physician
- Gladstone, OR
National Provider Identifier
1568412351
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 11183
- Practice address
- 1105 Portland Ave
Suite 2
Gladstone, OR 97027-2170 - Phone
- (503) 655-2404
- Fax
- (503) 655-1581
- NPI assigned
- May 11, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 11183 | OR | Primary |
Addresses
Primary practice location
1105 Portland Ave
Suite 2
Gladstone, OR 97027-2170
Mailing address
1105 Portland Ave
Suite 2
Gladstone, OR 97027-2170
Phone (503) 655-2404
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 059543 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11183 | OR | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Portland Adventist Medical Center | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Emergency Medical Services (Emergency Medicine) Physician
- Portland, OR
- NPI 1316502719
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203638400000",
"number": "1568412351",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1105 PORTLAND AVE",
"address_2": "SUITE 2",
"city": "GLADSTONE",
"state": "OR",
"postal_code": "970272170",
"telephone_number": "503-655-2404",
"fax_number": "503-655-1581"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1105 PORTLAND AVE",
"address_2": "SUITE 2",
"city": "GLADSTONE",
"state": "OR",
"postal_code": "970272170",
"telephone_number": "503-655-2404",
"fax_number": "503-655-1581"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KING",
"first_name": "GERALD",
"middle_name": "MARLIN",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-11",
"last_updated": "2008-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OR",
"license": "11183",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "059543",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gladstone, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.