Provider Demographics
NPI:1619957719
Name:KNITTIG, RICHARD ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALLEN
Last Name:KNITTIG
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 1:16658 PERDIDO KEY DR
Mailing Address - Street 2:#303
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507
Mailing Address - Country:US
Mailing Address - Phone:205-317-5200
Mailing Address - Fax:
Practice Address - Street 1:16658 PERDIDO KEY DR
Practice Address - Street 2:303
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-9322
Practice Address - Country:US
Practice Address - Phone:205-317-5200
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD 106064171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider