Provider Demographics
NPI:1255439345
Name:KNOX, STEPHEN MARTIN (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MARTIN
Last Name:KNOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6255 W SUNSET BLVD FL 21
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7422
Mailing Address - Country:US
Mailing Address - Phone:323-860-5200
Mailing Address - Fax:323-467-7119
Practice Address - Street 1:400 30TH ST STE 300
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3318
Practice Address - Country:US
Practice Address - Phone:510-628-0949
Practice Address - Fax:510-628-0947
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2024-05-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG063555207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G063555Medicaid
CAA53738Medicare UPIN