Provider Demographics
NPI:1073548665
Name:KNIGHT, JAMES GORDON (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GORDON
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3917 WEST RD
Mailing Address - Street 2:STE 138
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-2275
Mailing Address - Country:US
Mailing Address - Phone:505-661-9150
Mailing Address - Fax:505-661-9135
Practice Address - Street 1:3917 WEST RD
Practice Address - Street 2:STE 138
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-2275
Practice Address - Country:US
Practice Address - Phone:505-661-9150
Practice Address - Fax:505-661-9135
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC42180208800000X
NMMD2009-0744208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM85103276Medicaid
NM85103276Medicaid
NMNM302965Medicare PIN