Healthcare Provider Details

I. General information

NPI: 1164458998
Provider Name (Legal Business Name): SCOTT J MCKNIGHT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 N STATE ROUTE 291
LIBERTY MO
64068-1045
US

IV. Provider business mailing address

515 N STATE ROUTE 291
LIBERTY MO
64068-1045
US

V. Phone/Fax

Practice location:
  • Phone: 816-781-2900
  • Fax: 816-781-1370
Mailing address:
  • Phone: 816-781-2900
  • Fax: 816-781-1370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMDR5G65
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: