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General NPI Number Information
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NPI Number | 1942234331
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Entity Type | Individual
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Provider Name | GORDON C KNIGHT D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 11/04/2020
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Provider Practice Location Address
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Address Line | 4800 MEXICO RD STE 103
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City | SAINT PETERS
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State | MO
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Zip | 63376-1666
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Country | US
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Telephone | 314-909-0747
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Fax | 844-535-9135
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Provider Business Mailing Address
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Address Line | 4800 MEXICO RD STE 103
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City | SAINT PETERS
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State | MO
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Zip | 63376-1666
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Country | US
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Telephone | 314-909-0747
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Fax | 844-535-9135
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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 | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | R5C87
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | R5C87
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License Number State | MO
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