Provider Demographics
NPI:1396749347
Name:KNOX, JOHN MARSHALL II (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MARSHALL
Last Name:KNOX
Suffix:II
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 1:375 HUKU LII PL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-8996
Mailing Address - Country:US
Mailing Address - Phone:808-875-7477
Mailing Address - Fax:808-879-4585
Practice Address - Street 1:375 HUKU LII PL
Practice Address - Street 2:SUITE 201
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8996
Practice Address - Country:US
Practice Address - Phone:808-875-7477
Practice Address - Fax:808-879-4585
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9684207N00000X
HIMD12517207N00000X
WAMD60199612207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00985643OtherPALMETTO RR MEDICARE
WA0087KNOtherREGENCE
WA1396749347Medicaid
WA274442OtherLNI
H104436Medicare UPIN
H101280Medicare PIN
WAP00985643OtherPALMETTO RR MEDICARE
WA274442OtherLNI
H104436Medicare PIN