Healthcare Provider Details

I. General information

NPI: 1780655647
Provider Name (Legal Business Name): FIRST KNIGHT MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 05/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8508 ALAFIA HILLS DR
PLANT CITY FL
33567-3408
US

IV. Provider business mailing address

8508 ALAFIA HILLS DR
PLANT CITY FL
33567-3408
US

V. Phone/Fax

Practice location:
  • Phone: 813-650-8600
  • Fax: 813-650-8664
Mailing address:
  • Phone: 813-650-8600
  • Fax: 813-650-8664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME0068819
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberME0068819
License Number StateFL

VIII. Authorized Official

Name: DR. LAURENCE MILTON PETTY
Title or Position: PRESIDENT/PHYSICIAN
Credential: M.D.
Phone: 813-650-8600