Provider Demographics
NPI:1861496556
Name:KNIGHT, DANIEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:KNIGHT
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: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:318-716-1705
Mailing Address - Fax:318-716-1709
Practice Address - Street 1:2533 BERT KOUNS INDUSTRIAL LOOP STE 106
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3158
Practice Address - Country:US
Practice Address - Phone:318-716-1705
Practice Address - Fax:318-716-1709
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0171522086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1915963Medicaid
LA240003817OtherRAILROAD MEDICARE NUMBER
LA1915963Medicaid
LA5N517Medicare PIN
LA240003817OtherRAILROAD MEDICARE NUMBER
LAE85444Medicare UPIN