Healthcare Provider Details

I. General information

NPI: 1255392882
Provider Name (Legal Business Name): DOUGLAS D. KNIGHT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 5 MILE RD
CINCINNATI OH
45230-4346
US

IV. Provider business mailing address

7575 5 MILE RD
CINCINNATI OH
45230-4346
US

V. Phone/Fax

Practice location:
  • Phone: 513-232-6677
  • Fax: 513-733-8588
Mailing address:
  • Phone: 513-232-6677
  • Fax: 513-733-8588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50-001583
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: