Provider Demographics
NPI:1477517167
Name:KNOX, JASON R (DPM)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:R
Last Name:KNOX
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 STONECREST BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6860
Mailing Address - Country:US
Mailing Address - Phone:615-220-8788
Mailing Address - Fax:615-220-8688
Practice Address - Street 1:300 STONECREST BLVD STE 350
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6860
Practice Address - Country:US
Practice Address - Phone:615-220-8788
Practice Address - Fax:615-220-8688
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM710213ES0103X
UT307187-501213ES0103X
LADPM200005213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1629138Medicaid
LA4J861C976Medicare PIN
U88699Medicare UPIN
LA4J861C972Medicare PIN