Provider Demographics
NPI:1275573255
Name:KNOX, DAVID LUKE (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LUKE
Last Name:KNOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3561 JOHNSON MILL BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-5026
Mailing Address - Country:US
Mailing Address - Phone:479-521-0900
Mailing Address - Fax:479-521-7284
Practice Address - Street 1:3561 JOHNSON MILL BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-5026
Practice Address - Country:US
Practice Address - Phone:479-521-0900
Practice Address - Fax:479-521-7284
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR3751207T00000X
NMMD2005-0149207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR113498001Medicaid
AR113498001Medicaid
A14535Medicare UPIN