Healthcare Provider Details

I. General information

NPI: 1417796525
Provider Name (Legal Business Name): RICHARD ALEXANDER KNAB DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14TH STREET BLDG 13129
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

3946 SAINT JOHNS AVE APT 703
JACKSONVILLE FL
32205-9496
US

V. Phone/Fax

Practice location:
  • Phone: 904-542-7300
  • Fax: 904-542-7394
Mailing address:
  • Phone: 703-475-5792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: