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NPI Code Detail

MEDICARE: ELLIS M. KNIGHT MD

MEDICARE: ELLIS M. KNIGHT MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianMD2022-0306NM
2207R00000XInternal Medicine Physician80976GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
180976OTHERGAGA BOARD OF MEDICAL EXAMINERS

General Provider Information

NPI Number : 1699716340
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLIS M. KNIGHT MD
Provider Business Mailing Address
First Line : 530 DE MOSS ST
Second Line :
City : LORDSBURG
State : NM
Zip : 88045-2618
Country : US
Telephone Number : 575-542-8384
Fax Number : 803-296-7330
Provider Business Practice Location Address
First Line : 1007 N POPE ST
Second Line :
City : SILVER CITY
State : NM
Zip : 88061-5161
Country : US
Telephone Number : 575-388-1511
Fax Number : 575-313-8236
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2006
Last Update Date : 04/29/2022

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