Provider Demographics
NPI:1699193540
Name:DANIEL R. KNIGHT, MD, LLC
Entity Type:Organization
Organization Name:DANIEL R. KNIGHT, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-798-4595
Mailing Address - Street 1:PO BOX 53316
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71135-3316
Mailing Address - Country:US
Mailing Address - Phone:318-798-4595
Mailing Address - Fax:
Practice Address - Street 1:7607 FERN AVE
Practice Address - Street 2:#502
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5739
Practice Address - Country:US
Practice Address - Phone:318-798-4595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty