Provider Demographics
NPI:1831186774
Name:KNIGHT, BRIAN GEORGE (DO)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:GEORGE
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 NE BURNSIDE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030
Mailing Address - Country:US
Mailing Address - Phone:503-489-1999
Mailing Address - Fax:503-489-2011
Practice Address - Street 1:1217 NE BURNSIDE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030
Practice Address - Country:US
Practice Address - Phone:503-489-1999
Practice Address - Fax:503-489-2011
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD021549204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
D97466Medicare UPIN
OR132712Medicare ID - Type Unspecified