Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 0101035672 | VA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | D0035281 | MD |
NPI | 1255494332 |
---|---|
Provider Name | Aubrey Lee Knight |
First Address | Roanoke, VA 24014-2462 |
Second Address | Roanoke, VA 24014-2462 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 12/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4073550-00 | (05) | MD |
C47178 | (02) | |
MC10074 | MEDICARE PTAN (01) | VA |
VV8414A | MEDICARE PTAN (01) | VA |