Healthcare Provider Details

I. General information

NPI: 1831186774
Provider Name (Legal Business Name): BRIAN GEORGE KNIGHT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 NE BURNSIDE RD SUITE 103
GRESHAM OR
97030
US

IV. Provider business mailing address

1217 NE BURNSIDE RD SUITE 103
GRESHAM OR
97030
US

V. Phone/Fax

Practice location:
  • Phone: 503-489-1999
  • Fax: 503-489-2011
Mailing address:
  • Phone: 503-489-1999
  • Fax: 503-489-2011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberD021549
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: