Provider Demographics
NPI:1134182306
Name:KNIGHT, JOHN ALBERT (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ALBERT
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 981
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-0981
Mailing Address - Country:US
Mailing Address - Phone:860-925-6452
Mailing Address - Fax:
Practice Address - Street 1:1331 BANDERA HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-9535
Practice Address - Country:US
Practice Address - Phone:830-895-7755
Practice Address - Fax:830-895-7757
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD4183207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162256502Medicaid
TX8J3301OtherBCBS
TX8J3301OtherBCBS
TX162256502Medicaid