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General NPI Number Information
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NPI Number | 1891773552
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Entity Type | Individual
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Provider Name | JON FRANCIS KNICKREHM D.O.
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Gender | Male
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Dates
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Enumeration Date | 01/04/2006
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Last Update Date | 02/27/2013
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Provider Practice Location Address
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Address Line | 12511 WORLD PLAZA LN BLDG 50
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City | FORT MYERS
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State | FL
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Zip | 33907-3991
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Country | US
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Telephone | 239-939-2622
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Fax | 239-939-0151
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Provider Business Mailing Address
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Address Line | 10201 AVALON LAKE CIR
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City | FORT MYERS
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State | FL
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Zip | 33913
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Country | US
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Telephone | 239-768-7171
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Fax | 239-939-0151
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | DO-596
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License Number State | AL
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