Healthcare Provider Details

I. General information

NPI: 1780844431
Provider Name (Legal Business Name): JESSE KNIGHT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2376 N 400 E STE 202
TOOELE UT
84074-3413
US

IV. Provider business mailing address

2561 S 1560 W UNIT B
WOODS CROSS UT
84087-2361
US

V. Phone/Fax

Practice location:
  • Phone: 435-833-9600
  • Fax: 435-882-4743
Mailing address:
  • Phone: 801-505-0821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number11810844-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: