Healthcare Provider Details

I. General information

NPI: 1871584375
Provider Name (Legal Business Name): DOUGLAS J MCKNIGHT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HHC 2X UNIT #15077 BOX 703
APO AP
96224
US

IV. Provider business mailing address

HHC 2X UNIT #15077 BOX 703
APO AP
96224
US

V. Phone/Fax

Practice location:
  • Phone: 11-339-6059
  • Fax:
Mailing address:
  • Phone: 11-339-6059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPAO1952
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: