Provider Demographics
NPI:1114991122
Name:KNECHT, JAMES LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LEE
Last Name:KNECHT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:KNECHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:505 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:OK
Mailing Address - Zip Code:73077-5021
Mailing Address - Country:US
Mailing Address - Phone:580-336-2209
Mailing Address - Fax:580-336-4584
Practice Address - Street 1:505 N 14TH ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:OK
Practice Address - Zip Code:73077-5021
Practice Address - Country:US
Practice Address - Phone:580-336-2209
Practice Address - Fax:580-336-4584
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2238208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK896329OtherAETNA
OK100100500AMedicaid
010028289OtherMEDICARE-RAILROAD
731173034OtherTRICARE
731173034001OtherBC/BS OF OKLAHOMA
731173034001OtherBC/BS OF OKLAHOMA