Provider Demographics
NPI:1639437627
Name:MCKNIGHT, BRETT (MD)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:MCKNIGHT
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 1:515 N STATE ROUTE 291
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-1045
Mailing Address - Country:US
Mailing Address - Phone:816-781-2900
Mailing Address - Fax:816-781-1370
Practice Address - Street 1:515 N STATE ROUTE 291
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-1045
Practice Address - Country:US
Practice Address - Phone:816-781-2900
Practice Address - Fax:816-781-1370
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0439860207W00000X
MO2017010591207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBP10043164OtherTEXAS MEDICAL BOARD PHYSICIAN IN TRAINING PERMIT