Provider Demographics
NPI:1770740854
Name:KNIGHT, JESSE ROGOZA (MD)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:ROGOZA
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2916 NW BUCKLIN HILL RD # 381
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8514
Mailing Address - Country:US
Mailing Address - Phone:360-813-6021
Mailing Address - Fax:855-249-8011
Practice Address - Street 1:2916 NW BUCKLIN HILL RD # 381
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8514
Practice Address - Country:US
Practice Address - Phone:360-813-6021
Practice Address - Fax:855-249-8011
Is Sole Proprietor?:No
Enumeration Date:2008-05-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000468372085R0204X, 2085R0202X
WY16276C2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1770740854Medicaid
WA8954921Medicare PIN