Provider Demographics
NPI:1568536126
Name:KNIGHT, TIMOTHY E (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:E
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6500 N SOCRUM LOOP RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-4179
Mailing Address - Country:US
Mailing Address - Phone:863-853-3331
Mailing Address - Fax:863-853-3337
Practice Address - Street 1:6500 N SOCRUM LOOP RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-4308
Practice Address - Country:US
Practice Address - Phone:863-853-3331
Practice Address - Fax:863-853-3337
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86288207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1716600OtherAETNA - HMO
FL62853OtherBCBS
FL265978600Medicaid
FLDG5508OtherRAILROAD MEDICARE
FL2122854621301OtherBEECHSTREET
FL03-00964OtherUHC
FLP0044110OtherRAILROAD MEDICARE
FL08166OtherUNIVERSAL
FL11246701OtherCITRUS
FL7988417OtherAETNA - TRADITIONAL
FLAF582Medicare PIN
FL08166OtherUNIVERSAL
FL7988417OtherAETNA - TRADITIONAL
FL62853Medicare PIN