MEDICARE: CHARLES D KNIGHT JR. 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	2086S0129X	Vascular Surgery Physician	06896R	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	020021594	OTHER	LA	RAILROAD MEDICARE NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1053315846	OTHER	LA	GROUP NPI NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912901794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES D KNIGHT JR. MD

Provider Business Mailing Address
First Line	:	2064 SILVER POINT DR
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71106-7753
Country	:	US
Telephone Number	:	318-422-1274
Fax Number	:

Provider Business Practice Location Address
First Line	:	2064 SILVER POINT DR
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71106-7753
Country	:	US
Telephone Number	:	318-422-1274
Fax Number	:

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	11/24/2025

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