Provider Demographics
NPI:1790782035
Name:KNOX, ROBERT J (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:KNOX
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 1:1534 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-4524
Mailing Address - Country:US
Mailing Address - Phone:740-355-1161
Mailing Address - Fax:740-355-1191
Practice Address - Street 1:1534 11TH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4524
Practice Address - Country:US
Practice Address - Phone:740-355-1161
Practice Address - Fax:740-355-1191
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-077740207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2187351Medicaid
OH4132381Medicare ID - Type UnspecifiedINDIVIDUAL
OH2187351Medicaid
OH9344241Medicare ID - Type UnspecifiedGROUP