Active NPI
Bradley Owen King, MD
- Emergency Medicine Physician
- Tyler, TX
National Provider Identifier
1639118367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- L0336
- Practice address
- 1000 S Beckham Ave
Tyler, TX 75701-1908 - Phone
- (903) 597-0351
- Fax
- (903) 525-9301
- NPI assigned
- Jun 6, 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 |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | L0336 | TX | Primary |
Addresses
Primary practice location
1000 S Beckham Ave
Tyler, TX 75701-1908
Mailing address
1000 S Beckham Ave
Tyler, TX 75701-1908
Phone (903) 597-0351
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0372286-04 | Medicaid | TX | |
| 930120767 | Other | TX | RAILROAD MEDICARE |
| 8F6462 | Other | TX | BLUE CROSS |
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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L0336 | TX | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cherokee Emergency Medicine Associates PA | Emergency Medicine | Past | Accepting new patients |
| Singleton Associates PA | Past | Accepting new patients |
Organizations & group practices 2
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.
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- NPI 1538107875
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404864000000",
"number": "1639118367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 S BECKHAM AVE",
"city": "TYLER",
"state": "TX",
"postal_code": "757011908",
"telephone_number": "903-597-0351",
"fax_number": "903-525-9301"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 S BECKHAM AVE",
"city": "TYLER",
"state": "TX",
"postal_code": "757011908",
"telephone_number": "903-597-0351",
"fax_number": "903-525-9301"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KING",
"first_name": "BRADLEY",
"middle_name": "OWEN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-06",
"last_updated": "2014-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "TX",
"license": "L0336",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0372286-04",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "930120767",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "8F6462",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.