Provider Demographics
NPI:1639282643
Name:KNIGHT, JAMES WALDEN (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WALDEN
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7601 NATURAL BRIDGE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-4904
Mailing Address - Country:US
Mailing Address - Phone:314-385-7300
Mailing Address - Fax:314-385-4874
Practice Address - Street 1:7601 NATURAL BRIDGE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-4904
Practice Address - Country:US
Practice Address - Phone:314-385-7300
Practice Address - Fax:314-385-4874
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO36181208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201445103Medicaid
MO000001384Medicare ID - Type UnspecifiedMEDICARE ID NUMBER
MOA09892Medicare UPIN