Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207NS0135X | Procedural Dermatology | ME89879 | FL |
NPI | 1194727586 |
---|---|
Provider Name | James Matthew Knight |
First Address | Orlando, FL 32801-1026 |
Second Address | Orlando, FL 32801-1026 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 17/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AH715 PTAN | PTAN AH715 (01) | FL |
I151211 | (02) | FL |