Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DE 00006898 | WA |
Y | 213EG0000X | General Practice | DE 00006898 | WA |
NPI | 1003108770 |
---|---|
Provider Name | Thomas Michael Knight |
First Address | Bainbridge Island, WA 98110-1782 |
Second Address | Bainbridge Island, WA 98110-1782 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2011 |
Last Update Date | 12/05/2011 |