Healthcare Provider Details

I. General information

NPI: 1639368442
Provider Name (Legal Business Name): DOUGLAS B KNOX MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 CARONDELET DR SUITE 140
KANSAS CITY MO
64114-4859
US

IV. Provider business mailing address

PO BOX 931043
KANSAS CITY MO
64193-0001
US

V. Phone/Fax

Practice location:
  • Phone: 816-943-0199
  • Fax: 816-943-0323
Mailing address:
  • Phone: 816-943-0199
  • Fax: 816-943-0323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number106993
License Number StateMO

VIII. Authorized Official

Name: DR. DOUGLAS B KNOX
Title or Position: PRESIDENT
Credential: MD
Phone: 816-943-0199