Provider Demographics
NPI:1679554422
Name:MCKNIGHT, THOMAS L (MD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:L
Last Name:MCKNIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4566 E HIGHWAY 20
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-8838
Mailing Address - Country:US
Mailing Address - Phone:850-729-9407
Mailing Address - Fax:850-729-9417
Practice Address - Street 1:4566 E HIGHWAY 20
Practice Address - Street 2:SUITE 105
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-8838
Practice Address - Country:US
Practice Address - Phone:850-279-6949
Practice Address - Fax:850-279-6033
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2014-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME91767207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine