Healthcare Provider Details

I. General information

NPI: 1386830263
Provider Name (Legal Business Name): J MATTHEW KNIGHT M D P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 04/12/2019
Certification Date:
Deactivation Date: 02/22/2019
Reactivation Date: 04/12/2019

III. Provider practice location address

801 N ORANGE AVE SUITE 520
ORLANDO FL
32801-1026
US

IV. Provider business mailing address

801 N ORANGE AVE SUITE 520
ORLANDO FL
32801-1026
US

V. Phone/Fax

Practice location:
  • Phone: 407-992-0660
  • Fax: 407-992-7702
Mailing address:
  • Phone: 407-992-0660
  • Fax: 407-992-7702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES MATTHEW KNIGHT
Title or Position: PHYSICIAN/PRESIDENT
Credential: M.D.
Phone: 407-992-0660