Provider Demographics
NPI:1922372788
Name:KNABB, KYLE MONROE (DO)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:MONROE
Last Name:KNABB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-2103
Mailing Address - Country:US
Mailing Address - Phone:904-259-7815
Mailing Address - Fax:904-259-4675
Practice Address - Street 1:159 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-2103
Practice Address - Country:US
Practice Address - Phone:904-259-7815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-26
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11662207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine