Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | C42180 | CA |
Y | 208800000X | Urologist | MD2009-0744 | NM |
NPI | 1073548665 |
---|---|
Provider Name | Dr. James Gordon Knight |
First Address | Los Alamos, NM 87544-2275 |
Second Address | Los Alamos, NM 87544-2275 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 14/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
85103276 | (05) | NM |
D97467 | (02) | CA |