Provider Demographics
NPI:1942234331
Name:KNIGHT, GORDON C (DO)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:C
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4800 MEXICO RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1666
Mailing Address - Country:US
Mailing Address - Phone:314-909-0747
Mailing Address - Fax:844-535-9135
Practice Address - Street 1:4800 MEXICO RD STE 103
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1666
Practice Address - Country:US
Practice Address - Phone:314-909-0747
Practice Address - Fax:844-535-9135
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR5C872086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO242527208Medicaid
MOA10771Medicare UPIN
MO242527208Medicaid