Provider Demographics
NPI:1932110467
Name:KNOX, RANDOLPH WILLIAM (PA)
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:WILLIAM
Last Name:KNOX
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 ALAMO AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-7303
Mailing Address - Country:US
Mailing Address - Phone:808-388-0061
Mailing Address - Fax:
Practice Address - Street 1:USAHC BAMBERG
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09139
Practice Address - Country:US
Practice Address - Phone:49951-300-8619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07845363A00000X
COPA.0005326363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX304595701Medicaid
NM27332586Medicaid
TX304595701Medicaid