MEDICARE: JOHN MARSHALL KNOX II MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	F9684	TX
2	207N00000X	Dermatology Physician	MD12517	HI
3	207N00000X	Dermatology Physician	MD60199612	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00985643	OTHER	WA	PALMETTO RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0087KN	OTHER	WA	REGENCE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	274442	OTHER	WA	LNI

General Provider Information

NPI Number	:	1396749347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN MARSHALL KNOX II MD

Provider Business Mailing Address
First Line	:	375 HUKU LII PL
Second Line	:	SUITE 201
City	:	KIHEI
State	:	HI
Zip	:	96753-8996
Country	:	US
Telephone Number	:	808-875-7477
Fax Number	:	808-879-4585

Provider Business Practice Location Address
First Line	:	375 HUKU LII PL
Second Line	:	SUITE 201
City	:	KIHEI
State	:	HI
Zip	:	96753-8996
Country	:	US
Telephone Number	:	808-875-7477
Fax Number	:	808-879-4585

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	01/27/2015

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Directions to “ JOHN MARSHALL KNOX II MD” Practice Location

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