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General NPI Number Information
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NPI Number | 1104612183
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Entity Type | Organization
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Legal Business Name | RED KNIGHT CLINIC LLC
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Dates
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Enumeration Date | 04/16/2025
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 345 MOKO PL
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City | LA CONNER
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State | WA
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Zip | 98257-9535
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Country | US
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Telephone | 360-466-8842
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Fax |
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Provider Business Mailing Address
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Address Line | 345 MOKO PL
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City | LA CONNER
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State | WA
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Zip | 98257-9535
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Country | US
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Telephone | 360-466-8842
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | WILBERT DANIEL JAMES
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Credential | MD
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Telephone | 360-466-8842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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