MEDICARE: MR. RICKY NORMAN KNOWLES

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	174400000X	Specialist	1130614	TX

General Provider Information

NPI Number	:	1447581426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICKY NORMAN KNOWLES

Provider Business Mailing Address
First Line	:	3106 MELODY PEAK LN
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77581-2553
Country	:	US
Telephone Number	:	713-484-9647
Fax Number	:	281-485-4262

Provider Business Practice Location Address
First Line	:	4615 SOUTHWEST FWY
Second Line	:	#420
City	:	HOUSTON
State	:	TX
Zip	:	77027-7108
Country	:	US
Telephone Number	:	713-484-9647
Fax Number	:	281-485-4262

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

Provider Enumeration Date	:	01/15/2010
Last Update Date	:	01/15/2010

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