Provider Demographics
NPI:1184729964
Name:MCKNIGHT, MAXEY DELL JR (MD)
Entity type:Individual
Prefix:
First Name:MAXEY
Middle Name:DELL
Last Name:MCKNIGHT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1181 LYTLE WAY
Mailing Address - Street 2:SUITE F
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-4299
Mailing Address - Country:US
Mailing Address - Phone:325-701-4818
Mailing Address - Fax:325-701-4429
Practice Address - Street 1:1181 LYTLE WAY
Practice Address - Street 2:SUITE F
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-4299
Practice Address - Country:US
Practice Address - Phone:325-701-4818
Practice Address - Fax:325-701-4429
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2009-04-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXF6935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC19184Medicare UPIN
TX8F9959Medicare PIN