Provider Demographics
NPI:1457436602
Name:KNAPP, ROGER S II (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:S
Last Name:KNAPP
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:PO BOX 99371
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0371
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:480 W SOUTHLAKE BLVD
Practice Address - Street 2:STE 133
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6162
Practice Address - Country:US
Practice Address - Phone:817-329-9234
Practice Address - Fax:817-329-9239
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1001208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87350SOtherBCBSTX IND PIN
TXKNARC17962OtherCCHIP PIN
TX152424OtherPHCS PIN
TX4369262OtherAETNA PIN
TX737821OtherFIRSTHEALTH PIN
TX00U87ZOtherBCBSTX GRP PIN
1750369203OtherGRP NPI NUMBER
TX117218102Medicaid
TX140442831Medicaid
TX47652OtherUHC PIN
TX140442870Medicaid
TX2961700OtherCIGNA PIN
TX140442831Medicaid
TX117218102Medicaid
TX152424OtherPHCS PIN