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General NPI Number Information
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NPI Number | 1932110467
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Entity Type | Individual
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Provider Name | RANDOLPH WILLIAM KNOX PA
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Gender | Male
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 06/01/2020
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Provider Practice Location Address
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Address Line | USAHC BAMBERG
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City | APO
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State | AE
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Zip | 09139
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Country | US
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Telephone | 499513008619
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Fax |
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Provider Business Mailing Address
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Address Line | 1525 ALAMO AVE
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-7303
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Country | US
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Telephone | 808-388-0061
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA07845
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0005326
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License Number State | CO
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